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Is there a solution to provider abuse of the Medicare System?

By Blake Marable | August 3, 2015

In a July 21 Wall Street Journal article, entitled: "Government Report Cites Shortfalls in Medicare’s Screening Process for Doctors," the writer, Christopher Weaver, states that a GAO report documents that thousands of doctors who bill Medicare have used questionable addresses. The article goes on to say that dozens of doctors have enrolled despite disciplinary actions by state medical boards.

How can this be? The federal government has spent millions of dollars probing for a solution to solve this problem that affects the $600 billion-a-year Medicare program.

Is there a solution available to healthcare organizations that can manage and maintain accurate provider information and help them keep unscrupulous physicians from abusing the system?

The answer is YES!

That solution is a Unified Provider Management (UPM) Platform that starts with each individual hospital’s unique footprint. The UPM begins by identifying each hospital’s target market geography of providers. This includes their county, state or multi-state area.  This provider information is loaded into the platform and compared with the hospital’s existing information, giving each hospital or health system an accurate, single profile for every provider in their clinical world.

Using the UPM platform hospitals and health systems then have the ability to manage their provider profiles (referring and credentialed physicians, nurses, and mid-levels) across all of their core IT clinical, financial and operational systems. The UPM allows healthcare organizations to unify, manage and share a single, verified, custom profile on each of their providers, regardless of where that data exists in their multiple IT systems.

Profiles are verified through the UPM and the very latest, accurate information on all providers is synchronized in real time to their IT systems and can be shared, based on permissions, across their entire hospital or health system via a private portal and mobile apps.

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