Ge-z, what will it take for the board to act?
14 replies (most recent on top)
@fa Very interesting theory re: Wire Fraud- "submitting fraudulent data to the government electronically is considered wire fraud (18 U.S.C. § 1343) if it involves a scheme to defraud, interstate communication (like the internet or email), and material misrepresentation to obtain money or property. It is a federal crime that can result in up to 20 years in prison and heavy fines. "
Wow! I can’t believe what FN has done to GBD at this company. But somehow losing Medicaid business and sc--wing up Medicare got her promoted!!
@a8 Exactly. If they can compile the data and put it on a zip drive, then they can upload it the way CMS requires. Makes you wonder if they are not uploading the required way because it would be a crime to submit the incorrect, potentially fraudulent data electronically. In addition to having to reimburse who knows how many millions of dollars.
@a8 I think the issue isn't that they don't have the ability to pull an electronic feed, they do that for other functions, I believe that either
A) the data they need to pull lives in various kluged together systems because Elevance has always su-ked at migrations. They hire consultants, spend a bunch of money, and when they run out of money they say mission accomplished, execs get their big bonuses and they do manual workarounds. (Look at Provider data). The data might also live on both sides of the Elevance-Carlon firewall. So they pull the data, merge it after the fact and put it on a zip drive.
B) the other scenario may be that they pull the data as mentioned in step A, and then further manipulate the merged data; would be interesting to know how much of these manual touches are ethical/allowable.
If they do a full audit, including looking at what is being touched offshore, I anticipate they'll look for a fall person to blame it on but I don't know if anyone's hands are clean on the cr-ppy, manipulated data issues!
I wonder how we remain FEDRAMP compliant with all the government data overseas. Someone may want to look into that!
@bn yes 100%! Many told them for YEARS! Just got your name entered on the Rif list. This is what happens when the incompetent is retained and elevated based on blind loyalty and protection. Good luck ELEVANCE. The momentum is getting faster every day.
So they've Riffed or driven out the worker bees who had any knowledge of how things work. They've retained their ar-e kissing BFF's and now someone needs to attempt to fix this mess. I would love to be a fly on the wall when they try to assign out the action items to the usual fixers only to realize they're all gone.
Guess they don't have to complete the Do The Right Thing training?
FAFO
They are not d-mb. They are playing games with CMS all these years and now CMS is tired of it..Big leader is behind this!!
Yep. Sounds about right for our Leadership. How hard is it to submit data the way CMS wants it? Apparently pretty hard for Elevance as they proven time and time again. Ever see how bad Encounters data rejects at this company and the inability to get it fixed? Pretty bad.
@a4 you are d-mb.
Haytaian is the gift that keeps on giving - that's his company - Carelon. I'm sure as he always has done - will point to anyone except himself.
Funny how that happened under FN, yet FN has been elevated anyway