AMG-SIU Information Center

A Fraudulent Heart

Joannah — Sat, 23 Aug 2008 00:17:41 +0000

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.

If you want to read the Chicago Tribune’s story visit it at: http://www.chicagotribune.com/news/nationworld/chi-heart-scam_22aug22,0,877564.story

Or you can check it out in Fierce Healthcare’s newsletter: http://www.fiercehealthcare.com/story/man-gets-350-000-heart-bypass-stealing-friends-identity/2008-08-22?utm_medium=nl&utm_source=internal&cmp-id=EMC-NL-FH&dest=FH

Going to NAMPI? We are!

Joannah — Thu, 21 Aug 2008 21:48:37 +0000

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!

AMG-SIU employees attend virtual SQL Server conference

thomas — Thu, 26 Jun 2008 23:42:50 +0000

AMG-SIU employees attended the virtual conference hosted by the SQL Server Worldwide User Group.

Up to $226 billion in healthcare fraud!

thomas — Tue, 27 May 2008 22:24:41 +0000

According to the “Financial Crimes Report“, the FBI estimates that between 3 and 10 percent of the $2.26 trillion spent on healthcare services are fraudulent. Healthcare fraud could cost Americans as much as $226 billion annually.

$371.5 Million of Medicare fraud in just 3 states

thomas — Wed, 05 Mar 2008 18:05:27 +0000

CMS identified $371.5 in Medicare overpayments in California, Florida and New York for the 2007 fiscal year. For more information please read their press release.

Microsoft Launch event

thomas — Wed, 05 Mar 2008 17:53:47 +0000

AMG-SIU’s IT staff was attending the Microsoft launch event for Windows Server 2008, SQL Server 2008 and Visual Studio 2008 in Los Angeles, CA. Microsoft demonstrated lots of new features during the many sessions and the keynote speech.

Suffolk County, NY awards Medicaid contract to AMG-SIU

thomas — Mon, 25 Feb 2008 19:14:04 +0000

Suffolk County RFP – To Provide Fraud and Abuse Prevention Plan Services for the Department of Health Services.

The Chief Purchasing Agent for Suffolk County, New York announced that the Allied Management Group (AMG)…”has been selected by the RFP Evaluation Committee as the apparent successful proposer for the above referenced Request for Proposal.” Suffolk County and AMG have agreed to contract terms. Services will be deployed following receipt of a signed contract. As of 2006 the State of New York has a total of 4,208,629 MediCaid recipients, of which 2,572,242 are enrolled via managed care plans. Suffolk County has a significant MediCaid enrollment to manage and/or monitor. AMG will provide the tools and service to manage this responsibility.

AMG-SIU encourages further education

thomas — Wed, 16 Jan 2008 21:29:52 +0000

Employees at AMG-SIU take classes at local colleges and universities, including prestige institutions such as the Extension Unit of the University of California, Irvine (UCI).

AMG-SIU Attends 4th Nationwide Health Information Network Forum

jon — Thu, 13 Dec 2007 00:37:57 +0000

On Tuesday, December 11th, 2007, AMG-SIU attended the 4th Nationwide Health Information Network Forum, which focused on sharing experiences from trial implementations of several HIEs (health information exchanges). The event gave the public a chance to interact with stakeholders from the public and private sector, including government and industry representatives. Work is continuing on standards harmonization through HITSP, the Health Information Technology Standards Panel, coordination of efforts/governance under the proposed AHIC 2.0 (American Health Information Community) with the Office of the National Coordinator of Health IT, and in many other organizations.

One of the most exciting and useful implementations of an HIE presented was that of the Camino de Salud/Long Beach Network for Health, which implemented a web-based electronic health record which, according to their studies, has actually been quite well received by their organizational stakeholders. Interestingly, this project consulted with the Kay Center for e-Health Research at the School of Information Science at Claremont Graduate University. AMG-SIU is proud to have three employees who are alumni of the CGU school of IS!

The challenges posed by creating such a large-scale, interconnected system such as a national health information network are no doubt immense and akin to the challenges in building the original Internet. With the enormous public and private support behind the effort, even if such a system is not adopted by everyone, the benefits of such a system may offer tremendous value for those who do use it. AMG-SIU wishes all stakeholders many successes and a safe, secure, private, vibrant and healthy future!

AMG-SIU expands again

thomas — Tue, 04 Dec 2007 00:51:29 +0000

AMG-SIU has doubled their office space and hired additional staff over the last quarter as a response to the high demand for their SIU services.