Digital Harbor

While Medicaid focus on mere member eligibility, the MCOs reap the benefit

August 3, 2016

The attitude, the opportunity and the environment together bolsters certain individuals to abuse the healthcare system. When it comes to ineligible beneficiaries, fraud permeates in different dimensions from eligibility abuse and card sharing to Doctor shopping and drug diversion. However, not all the Medicaid abuse is directly attributable to ineligible beneficiaries, but, the payout of huge lot of such unnecessary premiums

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Fraud – not just confined to Providers

July 6, 2016

Medicaid, a federal–state health-financing program for low-income and medically needy individuals, is a significant expenditure for the federal government and the states, with total federal outlays of $331 billion in fiscal year 2015. The federal watchdog Government Accountability Office estimates that about $29 billion of the payments made under Medicaid are “improper payments” which encapsulate fraud,

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Fraud and abuse – the inconvenient truth

June 1, 2016

Things tend to go wrong if left alone. One of the most popular Murphy’s law states that Anything that can go wrong, will go wrong. To me it’s a loosely coupled adaptation of second law of thermodynamics; entropy – the measure of “disorder” always increases with time. We have always seen a glass falling down and shattered to pieces, but we never observe pieces of glasses come together to form a glass (shattered glass is […]

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Doctor Shoppers ? Not all of them….or are they ?

May 4, 2016

Let’s begin with a story – A patient consults a physician for a particular chronic ailment; buys a controlled drug based on the physician’s prescription; not satisfied with the results, visits multiple physicians; gets multiple prescriptions on scheduled drugs, but still in vain. In this case, irrespective of whether the patient gets pain relief or not,

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Transforming Enterprises with Social Enterprise Technology Universal Platform

April 2, 2016

Equating today’s consumer internet to enterprise IT (B2B/B2E) is similar to comparing cheese to chalk. The consumer internet is awash with social media and mobile apps delivered from the cloud. Its ingredients are primarily unstructured data, free-form collaboration through conversational messaging and page sharing, and dynamic intelligence based on sentimental and behavioral analytics.

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