Task Force Recommends New Medi-Cal Computer System
The state's Medi-Cal computer system needs to be replaced to improve the identification and prevention of insurance fraud, according to a report from the Attorney General's Medi-Cal Task Force, the Central Valley Business Times reports. Medi-Cal is California's Medicaid program.
Fraudulent claims account for about $1 billion annually in Medi-Cal spending.
The report proposes a three-step process for state legislators to update the computer system, which was built in the 1970s and was not designed to prevent fraud. The proposed system would help improve the quality of care for beneficiaries, ensure timely payments to legitimate providers and help prevent fraud.
The current system's structure can make it difficult for government regulators to extract information about fraudulent claims, translating to a process of several months to identify the inappropriate charges to Medi-Cal.
The Medi-Cal Task Force recommends that the current system be replaced with one that uses new information technology applications to expedite claims processing and data mining tools to identify fraud and expedite payment of legitimate claims (Central Valley Business Times, 12/29/06).