Over seventy million Americans rely on Medicaid to receive health care. This program ensures that low-income individuals are able to receive health care, medications, and medical assistance while on tight budgets or living off of meager social security checks. With such a large portion of the American population subscribing to this health care program, it would stand to reason that it is being tightly regulated to keep error at a minimum.
Yet there is substantial evidence revealing devastating problems within Medicaid, among them insurance fraud, which costs the government billions of dollars in improper payouts each year. This issue impacts Americans in a serious and severe way, and public outrage has spawned a need for more in-depth review of this health care program.
Surprisingly, and perhaps most frustratingly, there is significant evidence that suggests the problem originates at the most basic level of this program, mainly data entry, and clerical error. This link between data entry error and false Medicaid payouts is impacting health care subscribers, the public, and the American government on a massive monetary scale. Reduced to the most basic level, data entry error is human error, and though an issue of this scale does not have an easy solution, it should be acknowledged in order to start affecting positive change.
Billions in Improper Payments
One of Medicaid’s most pressing concerns is the amount in false claims that is paid out each year. In 2014, Medicaid had an improper payout rate of approximately $17.5 billion, which is an error rate of 6.7%. This number is alarming enough but is even more so when considering the fact that this rate has increased each year, as 2013 indicates an erroneous payment rate of 5.7%, or a staggering $14.4 billion. Statistics like these are concerning on many levels, with billions being paid out for false claims when the money is needed for actual, deserving Medicaid beneficiaries.
A startling fact shows that a large portion of the erroneous benefits are being paid out to Medicaid subscribers who are actually deceased. In June 2015, two hundred people received $10 million worth of Medicaid benefits despite being dead for years. Cases like this are not uncommon, and though the fraud is linked to abuse from doctors, pharmacists, and government employees, it is also connected to the data entry programs implemented by Medicaid.
A closer look into this issue indicates that user fraud is one of the most pressing concerns. Since a large majority of Medicaid’s subscribers begin the health care subscription process online, the error begins during the registration process. Weak and insufficient data entry programs are at the core of this problem and allow for dishonest people who do not require Medicaid’s health care assistance to register and create online accounts.
Fixing at the Registration Level
With no discerning screening process to weed out these dishonest subscribers during initial registration, there is little to be done afterward to identify the culprits and enact the proper disciplinary actions. Essentially, once a person is integrated into the Medicaid system, there is an assumption of honesty and validity. Therefore, fixing the problem at the registration level is the key to beginning the process of correction.
Some analysts believe that creating an automated and standardized online registration process can assess provider risk upfront. One expert source claims that providing “accurate, standardized, and timely data during the registration process not only exposes would-be defrauders before they bill, but it also allows fee payers to use the resulting insights when providing predictive analytics to flag suspicious healthcare claims.” Instituting stricter data entry protocols would go a long way in ensuring user reliability, and less error in the long term.
Data Entry at the Heart of the Issue
How can an issue so massive in scale and consequence be resolved? Though human error can be a factor in such a complex problem, studies have proven that data entry is at the crux of this issue. So on one hand, a more detailed and thorough data entry software program is an ideal solution that would relieve much of the problem right at the source. Third party data can alleviate some of the challenges as well, as it can further verify self-provided information obtained by Medicaid’s initial registration process.
Some attempts have been made to correct the errors, as some states instituted frequent and mandatory online updates, but the time lapse between these updates have made it difficult to detect any patterns that arise during user fraud. Once the data begins accumulating, the search to identify user risk becomes nearly impossible. Thus, the solution must be integrated at the very source, during the initial data entry and user registration. Additionally, a more in-depth data analysis can help to further identify the risks and continue to help solve this costly problem.
For further information about data entry and analysis, websites like this one can be a valuable source of information with regards to explaining the complexities involved in implanting data registration programs.
Hurting the Economy and Americans
Erroneous Medicaid payouts effects the economy in immensely negative ways, and given the rate of error increase seen year to year, immediate corrective measures must be implanted lest the government continues to lose billions in fraudulent payouts.
Medicaid fraud affects all Americans, not just those seventy million people who subscribe to the health care program. With such a monumental amount of money being paid out to undeserving recipients as a result of data error, money that could be put to better use is being lost in the shuffle. As the government and the public are aware of the matter, thanks to widespread reports attempting to draw attention to such a grave issue, it is now time to try and mend the broken pieces of the system.
Implementing new data entry programs that ensure less possibility of error at the start can be a huge help in reducing fraud and preventing dishonest people from abusing the system. Medicaid is a necessary and lifesaving health care supplement for so many deserving Americans, and it is time to begin implanting strict and reliable programs within their data systems so that these deserving people can continue to benefit, and the government can distribute money in other, more deserving areas.
– DataEntryOutsourced
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