Open Innovation to Tackle Medicaid Fraud
Not only can you debug software using an intelligent crowd, but apparently you can also debug societal and ethical business problems. That's one thing you can take away from this open innovation project from Topcoder. It's a contest that aims to create software that can spot medicaid provider fraud from a mile away.
For a crach course on Medicaide fraud check this out, but, in short, fraud happens when patients are billed for services that weren't provided, or a provider simultaneously bills a private insurance company and medicaid for the same service, or the provider bills medicaid for visits the patient never attends, and a handful of other real-life morality 'cheat codes' that are employed by providers involving billing.
Here's what the Centers for Medicare & Medicaid Services has to say about the challenge:
The Center for Medicare & Medicaid Services (CMS) is committed to fighting Medicaid fraud, which diverts funds from needed medical care for the most vulnerable Americans. That's why we're announcing a challenge – the Provider Screening Innovator Challenge – to develop software tools that will help stop fraudsters from entering the Medicaid program under the pretense of serving patients.
Ok, so there's the problem, now comes the fun, nerdy, crowdsourced solution from Topcoder: Hold an open innovation contest for developers to create medicaide provider screening software. Topcoder is working in conjunction with the Center for Medicare & Medicaid Services to develop high-tech systems to evaluate forms and high risk public registrations (i.e., scans public-data for fishy info).
This project is also interesting for a number of other reasons:
- No government vendor contracts (the traditional route for government software solutions) are involved.
- The entire project will be open source, allowing any state to download & add state specific alterations
- The contest will take place on the Center of Excellence for Collaborative Innovation platform built by Topcoder
Another reason to take heed at this awesome innovation is this: TopCoder will speaking next month at Crowdopolis (July 19th in Los Angeles), and their topic will be about the atomization of complex open innovation projects. (This medicaid challenge is a great example of a atomized project, btw!)
In other words, they will be talking about large crowdsourcing projects that need to be segmented and planned out. In this case, the project will span 8-9 months, and it will consist of dozens and dozens of smaller open innovation contests.
Click here to learn more about the event & get to chat with Topcoder & other speakers including Stephen Shapiro (Author of Best Practices Are Stupid), GE, Nokia, and Kimberly-Clark.