Missouri adds tool vs. fraud

A health information company has signed a multiyear agreement to license

a fraud and abuse detection system for the Missouri Department of Social

Services' Division of Medical Services.

The Medstat Group, which is part of Thomson Corp., has designed a support

system called Advantage Suite that will enable Missouri to identify and

investigate fraud and abuse in the Medicaid program. The suite is a data

warehouse system designed to integrate disparate databases into a single

platform to ensure that information is accurate and can support enterprisewide

decision-making.

"New scams develop all the time and perpetrators can be very creative,"

said Pam Conrad, director of sales support for Medstat. The new system will

assist organizations that handle large volumes of medical services.

Medstat is partnering with the FourThought Group, an information systems

consulting group, in the Missouri agreement. As a subcontractor of Medstat,

FourThought will offer technical services, analytic consulting, on-site

support and many other services related to the implementation of the abuse-detection

system.

This multimillion-dollar arrangement, announced last week, is being

funded by state funds and federal tax dollars, Conrad said.

According to Conrad, no single solution exists to counter the fraud

problem. "We are always slightly behind the bad guys," she said. "However,

we will continue to enhance our system in order to address new forms of

problems as they arise."

Advantage Suite will be readily available in Missouri by January 2003,

but Medstat is providing early "leads" in September to enable organizations

to start using this tool against Medicare fraud and abuse.