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Minnesota leads game-changing national challenge

July 17, 2012

Minnesota’s Department of Human Services is teaming up with federal entities to solve a problem worth billions to American taxpayers. 

According to a recent Government Technology piece, “the federal government alone lost $22 billion to what it calls ‘improper payments’ in the Medicaid program last year.” These payments are going to providers involved in fraudulent practices such as billing for services that were never provided, double-billing both Medicaid and Medicare, and falsifying credentials or diagnoses.

“The result of the fraud … is a substantial drain on the money available to provide legitimate health-care services,” Government Technology reports. 

Taking aim at this problem, an innovator challenge is being issued with Minnesota acting as a leading state partner to NASA, the Harvard Business School, the Centers for Medicare and Medicaid Services and TopCoder®, Inc., a competitive global community of digital creators.

The Provider Screening Innovator Challenge began in late May. It is being seen as a game-changing strategy to apply reusable technology for states and the federal government. 

MN.IT Services @ DHS CIO Tom Baden said: “This innovative way to solicit application development will change how we source software development.” 

In addition to proving administrative cost savings, the challenge is expected to demonstrate the cost effectiveness of tapping into the public with open source technology. 

Application developers are being challenged to present a shared service solution to help states screen and re-validate providers of Medicaid and the Children’s Health Insurance Program (CHIP). Essentially it should result in an IT-driven method of verifying non-fraudulent providers of Medicaid and CHIP. Medicaid and CHIP provide health coverage to nearly 60 million Americans, including pregnant women, seniors and individuals with disabilities.

Individuals and teams from diverse fields within the general public can enter the challenge. Application development competitions in this series will be held using ‘Open Innovation,’ a TopCoder platform. 

Minnesota will be among the states that implement the winning solution. According to the parameters of the competition, it should be a multi-state, multi-program provider screening software application that streamlines operations. It should be capable of risk scoring, credential validation, identity authentication, and sanction checks. 

The contest also explicitly asks that the winning solution reduce administrative and infrastructure expenses, aligning it with the oft-stated goals of government at all levels. 

For more info on the challenge, go to: http://www.medicaid.gov/State-Resource-Center/Events-and-Announcements/Provider-Screening-Innovator-Challenge.html