Past Meetings

Success and Failures of States Insurance Reform. e.g., Massachusetts

2/18/11  Back

Our February Health TechNet meeting focused on the technology of compliance prevention and enforcement. 

The meeting featured the presentation of Tom McGraw, Senior Vice President for Government Program Integrity Solutions which provides predictive models, other analytics, fraud and abuse systems, and recovery services to 20 states and federal government agencies. Mr. McGraw provided us with an overview on fraud enforcement which is increasing under healthcare reform as part of the program's efforts to improve efficiency, raise revenue, and discourage intentional and even inadvertent non-compliance. Enforcement is no longer limited to willful abuse, but is directed at practices that may be unintentional but in need of correction. In this new environment, the industry must improve its systems and procedures to avoid erroneous claims practices and other arrangements that can lead to fines and severe penalties. He updated us on the current policies, practices and procedures, including hardware and software, that are being employed by the public and private sector to address this problem. 

The presentations of the speaker was followed by an active discussion among our members. This presentation is attached.