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La Florida prueba software del reconocimiento de voz para agrietarse abajo en el fraude de Medicaid

por Brendon Nafziger, DOTmed News Associate Editor | May 07, 2010
Using telephony to prevent fraud
Nurses and health aides around Miami checking up on Medicaid patients at home will have to put in a call to an automated voice recognition system to confirm they're actually carrying out their duties, a Florida health agency said on Wednesday.

The Florida Agency for Health Care Administration will run the pilot project, called Telephonic Home Health Service Delivery Monitoring and Verification, throughout Miami-Dade County.

In the program, nurses and home aides will have to have a recording made of their voices. At the beginning and at the end of their home visits to a Medicaid recipient, they will use the patient's telephone to ring up the automated system, which will try to match their voice against the one stored on file.

For patients who don't have a telephone, there will be alternative reporting schemes, said Sandata LLC, the company contracted by Florida to administer the program.

AN "AREA OF CONCERN"

Last year, the Florida legislature passed Senate Bill 1986, directing the health agency to test a telephone verification system that would help crack down on Medicaid abuse. The bill also declared the Miami-Dade County as "an area of health care concern" for fraud and abuse, a Florida health agency spokeswoman told DOTmed News.

"We're not saying all the providers in Miami-Dade are bad by any means, but we're saying it's an issue," Tiffany Vause, press secretary for the Florida health agency, said.

She cited a report from 2009 that found, over the past three years, an average of 90 percent of the expenses for Medicaid home visits came from Miami-Dade County, even though it is home to only 19 percent of Medicaid recipients.

"We were spending a lot of money [in Miami-Dade] for home health visits for only a small percentage of the population," she said.

Examples of the kinds of schemes perpetrated by shady home aides were visiting recipients' homes more times than necessary, billing for visits that never happened, and billing for a visit to an able-bodied recipient who didn't need, or qualify for, the home visit, according to Vause.

The pilot program, right now in the testing stages, will last three years, Vause said.