Wednesday, July 23, 2008

Open Source Medicaid 

By John LaPlante

Categories:  Medicaid

Yesterday morning I noted that a congressional hearing was going to hold a hearing on a federal bailout of state Medicaid programs. James R. Frogue, of the Center for Health Transformation, was one of the witnesses. You can read his testimony on the center’s website.

The 50 million people in Medicaid could, Frogue says, be served in better ways. He calls on Congress to put “on the Internet for all to see” “the set of claims that Medicaid providers send to the state for reimbursement for the treatment of patients.” He calls the idea “consistent with the transparency movement that is sweeping through government.” He calls it “open source Medicaid” which could improve patient health and help the public as well.

Frogue says that this information, appropriately scrambled to protect patient identity, “would lay bare to all whether or not Medicaid beneficiaries are getting appropriate medical care.”

It would also, he says, make more obvious cases of billing fraud and raise questions about inappropriate treatments, both of which could save taxpayer money.

There is plenty of room for fraud, as Frogue demonstrates through several examples and quotes from former Medicaid officials.



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