As states attempt to validate and cleanse Medicaid rolls, they have found themselves to be inept at truly identifying duplicate, ineligible recipients, which translates into millions of dollars in inappropriate spending. States have not begun to fully address the problem of paying managed care firms for patients that should not exist on Medicaid rolls because they are using old technologies to identify duplicate, ineligible citizens. Most states matching technologies are only capable of obvious identity matching and do not address non-obvious relationships.
IBM InfoSphere Risk & Compliance Software for Government and Healthcare uses analytic techniques to unmask individuals who are listed under false and/or duplicate identifications. The offering identifies individuals who are related through data thereby allowing the unmasking of networks that may be perpetuating Medicaid managed care waste, fraud or abuse. It allows states to:
- Verify applicant identity upon intake
- Determine if applicant is applying for same benefits
- Determine if applicant is applying for multiple benefits across several programs or jurisdictions
- Uncover hidden relationships between applicants and recipients
- Compare applicant eligibility information across programs to comply with privacy legislations
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