As we’ve said before - last week was a busy week for AMG-SIU. In addition to the CAHP conference, we attended  the Texas Association of Health Plan (TAHP) annual conference in The Woodlands, Texas.

What did we find interesting? The focus on politics. The conference broke down both McCain and Obama’s different politics on healthcare and how it will effect our industry. Both of the candidate’s recognize the need for healthcare reform and that’s a great beginning.

One thing we hope that both candidates will employ in healthcare reform is education. We find that of the claims that come back as possible, fraud, waste, abuse or error - many of them are because the doctor, hospital, etc. didn’t have the background education on how to submit that claim properly. Education is a powerful tool, and hopefully it’s one that both candidates will wield.  

This was a busy week for AMG-SIU, we attended two conferences one for the California Association of Health Plans (CAHP) in Palm Desert. 

The conference was educational, with several sessions dedicated to the growing pains California is experiencing within the health care industry and how to make healthcare affordable to more Californians. 

With our background, we of course think that one of the first steps health plans should make is to ensure that they’re doing everything possible to reduce fraud, waste and abuse within their companies through a claims editing system and education. On average, we find that approximately 10 percent of health plans’ claims dollars are spent unnecessarily on claims that are fraudulent, wasteful or made in error. 

By working with us, one of our clients has significantly reduced the amount of fraud, waste and abuse to 1-2 percent of their claims dollars- and that number will go down even further as they continue their education efforts.      

We made it. We traversed through the traffic of Orange County (which was considerable), traveled across Disneyland without aid of trams or monorails and walked a 5k on behalf of the children of Children’s Hospital of Orange County (CHOC).

More than 15 employees gave up their Sunday morning and arrived at Disneyland’s gates sporting their TEAM SIU t-shirts at 6:30 to walk around Disneyland and Disney’s California Adventure. The streets of Disneyland were more crowded than on a summer afternoon, and everyone was in a festive mood - with Minnie and Mickey waving and balloons filling the sky.

At AMG-SIU we’re more aware than most companies of how tenuous a bond someone’s health can be – we see it in the paperwork we process each day.  We also know how important it is to support organizations that are making a real difference in improving the health and well-being of its patients. Because of that, AMG-SIU is sponsoring Children’s Hospital of Orange County (CHOC) at its annual fundraiser, the CHOC walk. 

The walk takes place, Sunday, October 19^th at 7 a.m. at Disneyland.  The 5k walk is approximately 3 miles and will begin at Disneyland’s Main Street and will wrap through Disney’s California Adventure before finishing in Downtown Disney. If you’re interested in getting more information visit http://www.chocwalk.org.

We’ll be posting information and pictures on the website so stay tuned!

Here at AMG-SIU we come across interesting cases of fraud, waste and abuse all the time – but today, we came across fraud from a completely different source – the news.

Today it was reported that a man committed identity theft from a Medicaid patient to receive heart bypass surgery. Typically when you see someone steal an identity for medical benefits – it’s a one-time event: not for John Parsons. Parsons repeatedly committed fraud to secure a heart bypass surgery.

I’m probably wondering the same thing you are – how did he do this?

According to initial reports, it was not the internal or external vendors who caught the fraud: it was the caregiver of the man whose identity was stolen, Philip Johnson. Our own solution reports when any permanent characteristic is inconsistent with what we have on file such as birth date, sex, height and so forth – so we’ll be watching this story closely to make sure our own solution is capable of finding this type of fraud.

AMG-SIU’s very own COO Lori Lewis and the Director of Regulatory Affairs Barbara Lamberson, CFE will be attending the 24^th annual NAMPI conference next week in Williamsburg, VA. 

For those of you who are unfamiliar, the National Association of Medicaid Program Integrity (NAMPI) conference provides states with a venue to share information about their Medicaid programs and help each other prevent fraud, waste and abuse.  

If you’re attending and see Lori or Barbara around the conference, please stop and say hi!