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July 12, 2011 News 2 Comments

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The Government Accountability Office reports that the federal government’s systems for analyzing Medicare and Medicaid data for possible fraud are inadequate and underuse, making it difficult to detect the $60 to $90 billion in fraudulent claims paid out each year. The GAO also notes that:

  • CMS spent $150 million on new systems that went live in 2009, yet crucial pieces are missing.
  • The current systems don’t include Medicaid data and CMS’s plans to share Medicare and Medicaid data with states and implement new software have been delayed.
  • Of the 639 analysts who are suppose to use the system, only 41 have been trained so far.

CMS’s top anti-fraud administrator was scheduled to testify for a Senate subcommittee Tuesday to discuss the findings.

Reader Comments


From Bamma Bubba “Re: UCLA HIPAA violation settlement. Hospital snoops will never stop – it’s a people problem, not an IT problem. Could be a way to increase federal revenue, but then hospitals just pass the costs on to patient and insurers.” Yep, even though our mothers told us to mind our own beeswax, humans are generally just plain nosy. And at HIStalk we also like to make fun of people that can’t spell HIPAA.

HIStalk Announcements and Requests

Mr. H is still vacationing for a few more days. Either Mrs. H has banned him from the computer or he is in the Land of Bad Internet (I’m betting the latter) because I’ve hardly heard a peep from him in two days. Until his return, feel free to send any hot news my way. Or, if you don’t have hot news, just drop me an e-mail for the heck of it.


7-12-2011 5-15-54 PM

When Sidra Medical and Research Center (Qatar) opens in 2012, it  plans to run the Cerner Millennium platform and be the first fully digitized medical facility in the country.


Mediware hires Michael Anania as VP and GM of the company’s Blood Center Technologies product group. Anania’s previous employers include Roche Diagnostics and Baxter Healthcare.

7-11-2011 2-40-38 PM

MGMA names Susan Turney, MD its president and CEO, succeeding the retiring William F. Jessee, MD. Turney, who is an internist, has served as CEO of the Wisconsin Medical Society since 2004 and founded and chaired the Wisconsin Statewide HIE.

Apollo Health Street beefs up its sales force with the addition of four regional VPs: Ken Bartlett (SSI, McKesson), Dan Contilli (Healthation, SunGard), Troy McCormick (Invikktus, Emdeon) and David Richards (Dell Services, EPBS-Internedix.)

7-12-2011 4-13-40 PM

PointClear Solutions, a provider of HIT product development services, names Rodney Hamilton, MD, CMIO and managing director of its product strategy practice. Hamilton most recently was chief strategy officer for Vanguard Health Systems; he also spent time as a physician liaison with McKesson.

Announcements and Implementations

Predixion Software collaborates with the development team of Clinical Looking Glass to create a predictive model for reducing patient re-admissions. Clinical Looking Glass is a decision support tool that was developed at Montefiore Medical Center (NY).

7-12-2011 5-35-43 PM

Chelsea Community Hospital (MI) goes live next weekend on its $12 million EMR system. Chelsea is part of Trinity Health so I am assuming it’s a Cerner implementation.

7-12-2011 5-23-15 PM

The Indiana HIE reports that 70 distinct hospitals, long-term health facilities, and health systems were connected to the exchange as of the end of 2010. For the full year, IHIE delivered 3.3 billion pieces of clinical information, which is about 1.1 billion more than 2009’s totals.

Government and Politics

Arizona, Connecticut, Rhode Island, and West Virginia have now launched their Medicaid EHR incentive programs, bringing the total number of live state programs to 21. Only 14 of those states states have issued incentive checks.


7-12-2011 4-55-15 PM

Cerner is sponsoring a 10-week weight-loss competition aimed at helping Kansas City residents drop a combined 100,000 pounds. The KC Slimdown Challenge is expected to involve about 20,000 people. For the calculator-challenged, that’s about five pounds a person.

Corepoint Health is the top-rated vendor in KLAS’s just-released interface engine report. Corepoint has the largest presence of any vendor in smaller healthcare facilities but very few clients in facilities over 500 beds. InterSystems was ranked a close second, though almost all InterSystems Ensemble customers are in 500+ bed facilities.

Sponsor Updates

7-12-2011 6-23-25 PM

  • Cumberland Consulting Groups promotes Erik Howell to principal. Howell has managed multiple HIT projects for Cumberland since joining the company in 2004.
  • Surgical Information Systems is hosting a July 13th webinar on how social media affects healthcare.
  • PatientKeeper’s 2011 User Group Conference is scheduled for September 18-21 in Denver.
  • Lori Prestesater, RelayHealth’s VP of strategy and business development, will be discussing ACOs and Meaningful Use as a panelist at the Institute for HIT’s summit July 26-27 in Denver.  Also at the summit: Software Testing Service CEO Jennifer Lyle, who will join a panel discussion on strategies to achieve Meaningful Use.
  • URAC awards accreditation to MEDecision’s Alineo health utilization management platform.
  • Cancer Treatment of America  selects CareTech Solutions’ Service Desk to provide 24x7x365 IT support for its national network of  centers.
  • Concerro is offering a July 23rd webcast on nursing documentation and reimbursements. Coding expert Glenn Krauss will lead the discussion.
  • Karen Knect of Encore Health Resources will overview e-Measures during a online session July 13th.
  • The Los Angeles County Department of Health will implement Wellsoft Emergency Department Information Systems at its Los Angeles County and USC Medical Center hospitals.
  • Vocera Communications names John McMullen to its board of directors. McMullen is a SVP and treasurer at HP and will serve as chairman of the audit committee.
  • GE Healthcare launches its fully integrated EMR/PM system, Centricity Practice Solution 10.
  • CynergisTek CEO Mac McMillan will be a panelist for the launch of Clearwater Compliance’s HIPAA-HITECH Blue Ribbon panel July 14th.


Mr. H, Inga, Dr. Jayne, Dr. Gregg.

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Currently there are "2 comments" on this Article:

  1. Re: GAO findings
    Medicare hires incentized insurance investigators for RAC Audits and I would bet they would be better served using the same approach for auditing fraudulent claims. But then the true cost of Medicare waste would be known so let’s not do that. And Medicare would have to pay the incentives from their own pocket – can’t have that either even though the potential savings would be huge. Let’s see: 639 analysts at $100k each is $63M/yr plus $150M so far for a failed system? If they can’t get Medicare fraud under control after almost 50 years, what will happen with Obamacare?

  2. To Bamma Bubba who said: “Could be a way to increase federal revenue, but then hospitals just pass the costs on to patient and insurers.”…

    Since when does healthcare “pass the costs” on to anyone? We are an industry that (a) has little influence over what its payments are, (b) has little control over who its customers are, (c) has high degree of regulatory demands, and (d) has high incident rates for litigation (to support our legal “friends” often). What a crazy industry to work… but we love it!

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