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> The U.S. Department of Health and Human Services uses Palantir to detect Medicare fraud. Having worked in this field, I can say that this is hilarious overki
by dangerlibrary 9y ago
> The U.S. Department of Health and Human Services uses Palantir to detect Medicare fraud.
Having worked in this field, I can say that this is hilarious overkill. The vast majority (in dollar terms) of Medicare/Medicaid fraud is drug companies misreporting their Average Market Price (AMP), the critical variable in how much they get paid. In 2012, Glaxo settled(!) a small bundle of cases, some of which I worked on, for three billion dollars [0].
You don't need police-state surveillance of individuals, you need visibility into company transaction records.
[0] https://www.justice.gov/opa/pr/glaxosmithkline-plead-guilty-and-pay-3-billion-resolve-fraud-allegations-and-failure-report https://www.justice.gov/opa/pr/glaxosmithkline-plead-guilty-...
- refurb 9y agoMedicare fraud goes well beyond price reporting by manufacturers. Physicians can bill for more expensive procedures, bill phantom patients, etc. That's a huge part of the multi billion dollar fraud that Medicare has. I assume being able to identify physicians will outlier billing patterns would be helpful in figuring out where to look closer.
- dangerlibrary 9y agoI mean, if you want to get into it, you're both right and wrong. The second largest cases are typically against hospital chains that encourage (read: basically force) their coding teams to use particular billing codes. It's easy enough to model this from claims data (and we did). When a chain buys a new hospital, suddenly patients that present with the same diagnosis codes are all getting extensive exams that ostensibly require 45+ minutes of a physician's time and cost 4-10x more. Again - the large operators (hospital chains) absolutely dwarf individuals (doctors). DOJ barely has the resources to prosecute the largest offenders, and have faced repeated budget cuts. Wasting time on individual doctors or private practices (beyond maybe making examples of a few egregious actors) would be an inefficient allocation of their resources.
- ng12 9y agoDo you know the details of Palantir's investigation? How do you know they're not doing exactly what you just described? Palantir is just a data analysis company, they're not the NSA.
- creaghpatr 9y agoMedicare fraud is estimated to be around $60B per year or 10% of the whole budget. So if Palantir can decrease that rate by 1 or 2% then it's tough to call that overkill http://abcnews.go.com/Politics/medicare-funds-totaling-60-billion-improperly-paid-report/story?id=32604330 http://abcnews.go.com/Politics/medicare-funds-totaling-60-bi... >Going even further back, in 1998, a Senate investigation into Medicare fraud found $6 million in payments to a “business” whose fake address would have been smack in the middle of the Miami Airport. >The report released today shows no improvement, but investigators say it is not that hard to fix the problem. >ABC News went to one of the locations listed in the report that was on Chicago’s Southside next to a porn shop, with no doctor’s office evident, where Medicare sent nearly $600,000 using an ineligible mailbox shop location as a billing address until 2013. Seems like exactly the kind of problem Palantir can solve to the advantage of taxpayers.