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Health Information Exchange Conference of Western Attorneys’ General July 19, 2010.

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Presentation on theme: "Health Information Exchange Conference of Western Attorneys’ General July 19, 2010."— Presentation transcript:

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2 Health Information Exchange Conference of Western Attorneys’ General July 19, 2010

3 Sandlot, LLC  A regional Health Information Exchange (HIE) connecting North Texas physicians, hospitals, and other healthcare providers.  ∙ 1.4 million patients  ∙ 1,400 physicians and staff trained  ∙ 350+ physicians feeding electronic clinical data  ∙ 7 connected North Texas hospitals  ∙ 50,000 clinical transactions per day

4 What Sandlot Does  1. Takes an Electronic Medical Record (EMR), which is a document electronically created during a physician/patient visit.  2. Incorporates that new EMR into the patient’s Electronic Health Record (EHR), which is the patient’s medical history.  3. Does this in real time and in a fashion that is parsable across disparate systems and interoperable with various EMR data sources.  4. Ensures the EMR and EHR can be displayed for providers throughout the community at the point of care.

5 LEWIS MORRIS Chief Counsel to the inspector general U.S. Dept. of Health and Human Services June, 2010 “Right now it’s a good bet that you can take millions from [HHS], and chances are, you’re not going to get caught.”

6 JAMES BUCHANAN Head of White-Collar Fraud U.S. Attorney’s Office - Houston April, 2010 “[Medicaid] is easy to steal from. I think we’ve made a dent but this is a very target-rich environment.”

7 TIM DELANEY FBI Head of White-Collar Crime Miami, 2007 “[Medicaid fraud] is a field where you can be a relatively recent immigrant new to America and not know anything about the healthcare system and open up your company and start billing.”

8 Current System  ∙ Dated - not digitized.  ∙ Think about law school, pre-Westlaw versus ease of researching and intelligence gathering in  ∙ Incredible opportunity to improve efficiency, identify inaccurate and improper billings, scan for fraud and reduce paper waste.

9 No Internal Innovation or Controls  ∙ Biggest innovation has been to add incentives for whistleblowers.  ∙ Harsher penalties – but only if the criminal is caught.  ∙ Not much prevents criminals from succeeding because the auditing and tracking is enormously out of balance with resources allocated to Medicaid Fraud Control Units.

10 Medicaid Fraud Control Units (MCFUs)  ∙ Federally subsidized independent watchdog groups which are normally housed in the state AG’s offices.  ∙ 2008: 1,851 staff members and received $184 million in federal support.

11 MFCU Convictions and Recovery  ∙ 1997: 871 Cons, $ 147 million  ∙ 2003: 1,096 Cons, $ 268 million  ∙ 2008: 1,314 Cons, $ 1.3 billion

12 Georgia MFCU  ∙ Georgia has a successful HIE.  ∙ The increased the use of data analysis to assist Georgia’s MFCU in tracking fraud has increased the state’s recovery number by $10 million in two years.  ∙ From $16 million in 2007, to $26 million in 2009.

13 10 th Circuit Ruling  ∙ Becker v. Kroll 494 F.3d 904, C.A.10 (2007)  ∙ MFCU search and seizure case.  ∙ Court views search and seizure narrowly, saying search was constitutional, precedent for MFCUs to have broad authority to search medical records.

14 2 nd Circuit Ruling  ∙ U.S. v. Singh 390 F.3d 168, C.A.2 (2004)  ∙ MCFU search and seizure case.  ∙ Court relies on the good faith exception to probable cause concerning the search warrant.

15 7 th Circuit Ruling  ∙ U.S. v. Nechy 827 F.2d 1161, C.A.7 (1987)  ∙ Search of pharmacy.  ∙ “…if a search is objectively reasonable, the motives of the officers conducting it will not turn it into a violation of the Fourth Amendment.”

16 Recommendations  ∙ Consider mandating e-prescribe in your states.  ∙ Consider mandating that Medicaid providers participate in a Health Information Exchange solution.

17 Job Creation  ∙ Data Liaisons  Explain and interpret findings  ∙ Data Miners  Provide information to liaisons  ∙ Tech Support  Keep the system functioning properly

18 3 Click Solutions  ∙ Kymber Messersmith  ∙  ∙  ∙ Alex Buckley  ∙  ∙

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