MicroPact Blog

Helping Investigators Fight Medicaid Fraud

Attendees at National Association of Medicaid Program Integrity (NAMPI) Annual Conference Learn What entellitrak Can Do

Dion Trahan's avatar

By: Dion Trahan

September 11, 2013 | EventsCase Management/BPM

State Medicaid Fraud Control Units have recovered $3 billion that was illegally collected by individuals and businesses.

Medicaid fraud can include all sorts of cases – from pediatric dentists who charge Medicaid for unneeded work to mortuaries that submit bills to the system for funerals that never take place. The list of examples of fraud goes on and on.

Fraud, waste and abuse in the Medicaid system is a major problem that shows no signs of going away any time soon. Tracking down each of these cases and processing them requires dedicated investigators and a dynamic case management solution. This work is the job of the more than 15,000 Medicaid Fraud Control Units across the U.S.

This undeniable need for dynamic case management software was emphasized again and again at the National Association of Medicaid Program Integrity annual conference in Baltimore last week. Over the course of three days, I met with several state program integrity directors who were eager to learn how entellitrak, MicroPact’s enterprise Case Management and Business Process Management (BPM) platform, can help them combat fraud, waste and abuse.

Even though there were a lot of impressive technologies on display at the conference, none of them offered a solution that started with a true case management platform designed to give more control to the people doing all the work on each case.

Medicaid Fraud Control Units are overworked, to say the least. These offices are charged with conducting all sorts of statewide investigations relating to potential fraud. These investigations are often complex and can span months or even years.

MicroPact’s Data-First™ approach to case management puts the power squarely in the hands of the knowledge workers. By empowering more front-line workers, entellitrak offers organizations such as Medicaid Fraud Control Units a powerful tool to handle critical operations.

“Can you imagine trying to do all this without a case management system?” one attendee asked me. Another described how her investigators used a complex system of scratch paper, Excel spreadsheets and Word documents to detail the events and important facts of their investigations.

“There is no one place where my investigators can keep all of their notes and images… What is most frustrating to me is I cannot track our return on investment in real time against metrics we are measured against to the state legislators,” the attendee told me.

So I asked if she ever heard of MicroPact and entellitrak. We walked to our booth and I showed her how entellitrak could help her team. After five minutes she looked at me and said, “Where have y’all been my entire career?”

“I don’t know,” I replied. “But now we’re in Baltimore and this is entellitrak.”

If you would like to find out how entellitrak can help your organization empower the front-line workers with the Data-First approach to case management, request a free prototype.

About the Author

Dion Santana Trahan was Director, Healthcare & Benefits Solutions Strategist with MicroPact from 2012 - 2016.