Robin Mathias's blog

State Bidding News: Wisconsin, Colorado, Iowa

News and Commentary

Wisconsin and Colorado have released RFPs. Iowa is going to announce decisions by the end of the month about its Medicaid Enterprise Systems & Professional Services contract awards.

Wisconsin Medicaid Fiscal Agent Contract Procurement

The Department of Health and Family Services (DHFS), Division of Health Care Financing, announced issuance of the Request for Proposals (RFP) to procure a new Medicaid Management Information System (MMIS) and Fiscal Agent services contract to meet the informational, operational, and administrative needs of the day-to-day management of the $3.8 billion Wisconsin Medicaid program and other DHFS programs. The RFP was issued on VendorNet on April 29, 2004 and is posted at their website. Proposals are due July 27, 2004 by 4:00 PM CDT.

Studies Question Effectiveness of Artery-Opening Operations

News and Commentary

Studies Question Effectiveness of Artery-Opening Operations - A new and emerging understanding of how heart attacks occur indicates that increasingly popular aggressive treatments may be doing little or nothing to prevent them. [New York Times Healthcare News]

This article helps shine some light on the Tenet case of Redding cardiologists who have been accused of performing hundreds of unnecessary bypass surgeries. In Redding, the cardiology center aggressively marketed heart surgery as preventive care. This article cites studies of the ineffectiveness of bypasses and stents as preventive measures and describes how cardiologists end up putting their financial interests above their patients’ interests.

Doctor charged with health care fraud

News and Commentary
Doctor charged with health care fraud - - Wed Mar 17, 07:24 am GMT [News4Sites Healthcare] A Nashville, TN doctor has been charged with Medicare fraud. This is a little reminder that healthcare fraud is everywhere, not just in New York, New Jersey, Florida and California. As more claims are submitted electronically (particularly in a growing trend of web-based claim submission), it is not even necessary for criminals committing fraud to live in the same state as the agency they are defrauding. As New York, New Jersey, Florida and California get better at finding fraud, you should expect fraud to be exported to other areas of the country. It is easier for criminals to continue using the same scams with different targets that to come up with new scams.

March 2004 Newsletter


This Month’s Report:

  • The Art of Deception
  • Growth Hormone Bust
  • Data Warehousing
  • Appearances

The Art of Deception

I’m reading “The Art of Deception” by Kevin Mitnick, a famous hacker. You’ve got to read this book. You’ll learn to take security a lot more seriously. Mitnick describes scam after scam that involve social engineering—tricking people into thinking they should give you information. The lesson is that all the systems in the world won’t stop fraud by themselves. Only people can stop fraud.

Most of the scams he describes do not require a computer. The scams work by convincing people that the scam artist is somebody they should trust, such as the vice president in the LA office, the security consultant or some coworker you’ve never met. They provide just enough believable information to get the next bit of information they need for their scam. Read more.

New Data Sought in Federal Probe of Tenet

News and Commentary

New Data Sought in Federal Probe of Tenet - Los Angeles Times Mar 4 2004 8:27AM GMT [Healthcare Management News]

Tenet is in trouble again. This time it’s about possible kickback arrangement with physicians in Texas. Tenet is the second largest hospital chain in the US. This allegation is just one more of many that have been brought in the past few years. I’ve written several articles about Tenet and talked about some of the issues in an interview on CNBC. Read the other articles

When Your Doctor Goes to the Beach, You May Get Burned

News and Commentary

When Your Doctor Goes to the Beach, You May Get Burned - Studies show that most doctors feel they can take advantage of the free offerings of the pharmaceutical companies without being influenced. [New York Times Healthcare News]

If they think this, they can take advantage of drug company perks without feeling guilt. This reminds me of an article earlier in the month Making Drugs, Shaping the Rules where State government officials argued that they are not influenced by pharmaceutical companies funding their disease management programs.

Healthcare Fraud in South Africa

News and Commentary

Here’s a good article about fraud control in South Africa.

One of the things they talk about is calling patients when a doctor billed more services in a day than he could possibly perform. A key to making that work well is being able to identify outliers immediately and call patients before they forget the service or move. Often analysis like this is not done for a least a month after the claim was paid, which can be long after the service was provided. Having a report within 24 hours of processing the claims (and before th

Miami Medicare and Accident Scam

News and Commentary

Around South Florida Fri, Jan. 30, 2004 Miami Herald

“Federal agents Thursday arrested eight Miami-Dade residents accused of spearheading a two-tiered fraud of both the public Medicare system and private automobile insurers to the tune of $5 million.”

Back in August, I said that auto accident fraud rings were also committing health insurance fraud, because they already had the perfect setup. Tacking on healthcare fraud to the accident fraud would be almost pure profit (Accident Ring).

State moves against one of state's top Medicaid drug prescribers

News and Commentary | Medicaid Fraud Cases
State moves against one of state’s top Medicaid drug prescribers - AP via Florida Times-Union Feb 3 2004 4:27AM GMT [Healthcare Management News]

The State of Florida accused Dr. Armando Angulo of inappropriately prescribing over $2 million of Oxycontin and other narcotics since 2000. According to this article, Dr. Angulo even let clinic staff hand out pre-signed prescriptions on days he was not in the office.

Read my article about Oxycontin abuse

Making Drugs, Shaping the Rules

News and Commentary
Making Drugs, Shaping the Rules - The drug industry has eagerly helped states set medication guidelines for new antipsychotic medicines. [New York Times Healthcare News]

Whenever I hear about States funding disease management programs with money from pharmaceutical companies I get a little queasy. It feels like having the fox design and build the hen house.

In this article Melody Petersen tells us about how pharmaceutical companies helped pay for development of guidelines that recommend new drugs for the treatment of schizophrenia—drugs that cost $3,000 per year per person, instead of $250. “A Johnson and Johnson subsidiary that sells Risperdal, paid $4,000 to fly two state mental health officials to New Orleans, where they dined at an elegant Creole restaurant in the French Quarter, visited the aquarium and met with company executives and Texas officials,” she reports.

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