As the year comes to a close, it’s tradition to reflect on the past year, the changes, the ups and downs and everything in between.

For AMG-SIU, I’m happy to say, it’s been an up year. We’ve taken on several new clients, worked on fun special projects, and have grown our wonderful staff to a diverse group of intelligent and dedicated workers.

We’ve been very fortunate in the people we have working for us, they’re all very special and not only are they gifted at what they do but they want to be here. We try to make it special with the monthly birthday celebrations, holiday parties and occasional dinner cruise, but it’s truly our employees that make us special.

Thank you to all our employees for everything that you do, we really appreciate your hard work and dedication. It does not go unnoticed!

So today started out as any normal day, the marketing department was hard at work on their projects when all of a sudden - our CIO flew into the room - “You will never believe what happened!”

It was hard to believe.

Anyone who constantly monitors the Medical Fraud, Waste and Abuse business probably saw the news today, New York recovered more than $551 million in Medicaid fraud this year alone, more than double what officials had estimated. The shocking part of this news, was the press release that followed it. The New York State Comptroller, Thomas DiNapoli came out with a statement that the system New York has been using - isn’t working. The Comptroller’s office had recently overseen an audit of the system and turned up $1.8 billion in overpayments.

We come across fraud, waste and abuse daily - but we don’t normally come across a figure as large as $1.8 billion. After reading through all the issues we found that many of the problems facing New York were the same issues that our potential clients face, but without the $1.8 billion pricetag.

The Comptroller identified a few cases of fraud that had gone undetected by the system and most likely - would go undetected in most systems available today (except our own). Why is that? Most systems create edits based on federal guidelines and codes and leave it at that. We know better than that. Because we’ve been in this business for more than 35 years, we know that the rules do not include common sense rules. Long ago when edits were done manually, that was understandable but now you have to include these rules in your editing software. We have common sense edits in our system that would notice that it’s illogical to give one patient 35 fillings in one day.

Let’s hope that the next iteration of New York’s system will include logic as well as the required guidelines, and that they’ll be able to figure out when guidelines and rules are in conflict with another and how to rank them so that the edits follow all guidelines!

That took us several years to do on our own, but it’s been worth it. The last time one of our clients was audited, nothing came up. Zero! Nada! The auditors weren’t able to come up with anything wrong with their system.

It’s always nice when you find out all your hard work was worth it.

SaaS presentation code camp 2007

Abhijit Gadkari, one of AMG-SIU’s Enterprise Architects, will be giving a presentation about Software as a Service (SaaS) at the upcoming Code Camp. People interested in the topic can attend this free presentation at the Rock & Roll Code Camp on January 27th & 28th in Fullerton, CA. Please register online and check out their other great presentations.

AMG-SIU wishes everybody merry Christmas and a happy New Year.

AMG-SIU was one of the first companies that recognized the importance of data and therefore hired or appointed a Chief Data Officer. As a result, Thomas Mueller has been promoted from Data Specialist to Chief Data Officer. One of the few other people that hold this rare title is Usama Fayyad at Yahoo!. As the title indicates, the Chief Data Officer is in charge of the company’s data. Some responsibilities include data extraction/exchange, data cleansing, data transformation, data loading and data maintenance.