Panel recommends replacing Calif. Medicaid computer system
NEWS IN BRIEF — Posted Jan. 22, 2007
A California Attorney General's task force is recommending replacing the state's Medi-Cal computer system, in part because it was never designed to prevent insurance fraud. The office's Medi-Cal Task Force noted that program-related fraud amounts to about $1 billion per year, out of a current annual budget of $34 billion. Medi-Cal is the state's Medicaid plan.
The task force, in a report issued last month, noted the 30-year-old Medi-Cal computer system is incapable of using data mining tools to identify fraud. Right now, it takes months to identify and extract information regarding suspicious claims, the report said.
The report also said a new system could help allow legitimate claims to be paid quicker, and could easily tell the difference between a fraudulent claim and a claim that merely has an "honest billing mistake."
No figure was given as to how much a new system would cost. The report said the state would need to accept proposals; then take bids to see how much it might cost.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/01/22/bibf0122.htm.