Medicaid Fraud Solution Would Revolutionize Texas Health Care Security

Inc. Magazine just published an article by Adam Levin, Chairman and Founder of CyberScout, with his take on the alarming increase in fraudulent claims within Medicare and Medicaid due to the proliferation of medical identity fraud.  This figure now exceeds $77 billion annually.

Big problem

This is no joke for Texas Medicaid dental providers or their clients considering the massive data breach of MCNA client and provider data obtained by hackers. The financial and personal information of some 8.9 million clients plus all their providers are in the wind.  It is going to land someday.

Levin's article is important because it highlights a solution to the problem, one that we have promoted for Texas to use for years, that of Castlestone Advisors and its president and CEO Jeff Leston.

Using secure technology

Castlestone's innovative approach integrates the established security protocols of the payment card industry with a method to process healthcare transactions securely. This system employs specialized payment cards for users, facilitating secure transactions at point-of-sale terminals. By analyzing various transactional factors, including time and location, alongside specific patient and facility details, Castlestone's technology can accurately assess the risk of fraud.

Apparently, according to the article, this system was put to the test in a successful 65-day trial with Medicare patients, demonstrating its effectiveness in reducing medical ID fraud.  We've reached out to Castlestone to get more details of this trial.

Get modern

Government pay and chase methods to recover fraudulent funds after the fact are old, inefficient and ineffective.

But pay and chase agencies employ staff and crow about recoveries making the government look good despite losing hundreds of millions of dollars to scammers.  But then the federal share doesn't have to be paid back.

Smart governments should be focussing on preventing fraud in the first place which is why this is such an important technology.

Will they ever get smart?

One Response

  • As an addendum to this positive & workable solution, the last thing provider dentists need to see is any tacked on service charge for card processing. Providers are already taking a big hit from the low fee schedule rates on dental Medicaid.

    We’ve already witnessed certain low-end discounted PPO & insurance plans aggressively attempt to pass on processing costs to dental providers. There’s no reason to assume dental Medicaid MCOs wouldn’t pull the same abuses on doctors w/ payment from virtual credit cards.

    Michael W Davis, DDS
    Santa Fe, NM

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