Tuesday, April 24, 2012

Bureaucrats resist an ingenius fraud detection plan | Concord Monitor

Bureaucrats resist an ingenius fraud detection plan | Concord Monitor:

'via Blog this'Re "O'Brien: Welfare Fraud 'Widespread' " (Monitor front page, April 6):
Ten months ago, while researching legislation at the State House, I became aware of the scope of alleged public assistance fraud across the United States. Continuing my research, I came in contact with a Midwestern company that was the industry leader in detecting mortgage fraud by mining public databases for information that detects risk factors associated with fraud.
Because its system was so successful in detecting mortgage fraud, the company was expanding its scope to government programs, primarily health care and welfare fraud, where an estimated $90 billion is lost just to health care fraud each year. Its ingenious software replaces the archaic system currently used - a post-payment fraud investigation - with a proactive solution that moves the fraud investigation to the front of the process, thereby intercepting potentially fraudulent claims before they are paid.
With a click of a button, the person entering the claim (before payment) receives a response in seconds, showing whether that claim has risk factors associated with fraud and, if so, the level of risk.

Test partnership

The company was looking for a small state to partner with to test-market its newest version of the software. Because I am a firm believer in using new technology to its fullest, I arranged for company representatives to fly to New Hampshire to give a presentation to the Health and Human Services Oversight Committee. Certainly, an opportunity like this is something we should jump at, isn't it? Much to my surprise, the reception I received at the meeting was less than I expected.
Although some on the committee seemed receptive, the Health and Human Services fraud detection people reacted defensively and negatively, just as they did in the Monitor article, when confronted with statistics showing that fraud is occurring. I wondered if we could ever break through the circle-the-wagons mentality put forth by bureaucrats intent on protecting their turf.
Commissioner Nick Toumpas said the recent data showing significant indications of fraud would require "further investigation" and that "you always have to look at where you're going to get the biggest bang for the buck in terms of investigating this type of thing." He and others then provided many excuses to try to minimize the statistics.
Unfortunately, the "further investigation" and "bang for the buck" comments used recently are the same self-serving and unsatisfactory responses given last year.
The study shows 9.1 percent of welfare recipients and 6.14 percent of Medicaid recipients not living in New Hampshire, and 56 dead people on Medicaid in New Hampshire, including one who died in 1983. It also shows numerous people who would be considered wealthy on Medicaid. It is troubling that despite being presented with this cutting-edge technology last year and with probable significant savings, the commissioner is not moving forward at full speed to replace his antiquated system and embrace the new technology.

Taxpayers deserve help

New Hampshire citizens deserve action. They should not have to pay another dime for fraud, simply because a commissioner refuses to acknowledge the problem and refuses to address his antiquated inefficient fraud detection procedures.
Commissioner, for many months now you have been aware of at least one high-tech company with a proven track record that has offered to partner with New Hampshire to institute this revolutionary fraud prevention software. And you have known that quite likely New Hampshire would have to pay only if fraud was uncovered.
Perhaps the commissioner could explain to New Hampshire citizens why no one from Health and Human Services ever contacted the company that offered to partner with New Hampshire to obtain more information? And why New Hampshire citizens are still paying for fraudulent claims? How long will it be before our bureaucracy acknowledges and properly addresses this problem?(next page »)



We can go on the Web and find out just about anything about anybody. Grom where they live, crime reports, etc. No excuse for not using that technology to track down fraud.
Start with the judicial system, that seems to have no clue that we have folks out there who are 'Serial Disability Settlement Seekers" They sue every company they work for and get the standard 40 grand settlement from companies so that company will not go to court. They know that a company would rather pay 40 grand in a settlement to avoid court costs. Yet you never hear of a judge saying, I see you have sued 3 companies here for on the job injuries.


Let’s start by weeding out the deadbeats and cheaters. Those are the people, government employees, the doctors, the hospitals and even private companies (selling to the government at huge marked up rates). Make laws with penalties that far exceed what the person or business got. Change bankruptcy laws and tax laws that exclude certain monies or property from being touched when fined, just because you put assets in a trust before being convicted of a crime it should not hide that money.

The better question to ask Commissioner Nick Toumpas would be, with all his state employees why can NH not find out if "9.1 percent of welfare recipients and 6.14 percent of Medicaid recipients not living in New Hampshire, and 56 dead people on Medicaid in New Hampshire, including one who died in 1983". This company mentioned uses public databases, these databases exist because NH has already entered the information.



maybe we need to send Commissioner Nick Toumpas back to the private sector for a refresher course on how to be an effective leader and decision maker
In a mere decade since he became a BIG Govt bureaucrat he has lost the principles that make for effective and frugal use of our taxpayer valuable $$$$$.....He has become one of THEM




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