Health Management Systems

Private data relating to hundreds of thousands of New York healthcare patients may have been provided to foreign nationals this year as a result of a now-contentious agreement involving the Office of Medicaid Inspector General and a key service provider, according to two individuals involved in the case.

OMIG has a $155 million contract with a firm called Health Management Systems (HMS) in order to evaluate if patients have a primary insurance company to bill other than Medicaid. These "third party insurance verifications" assist New York minimize the stress on the $57 billion Medicaid program for patients who need publicly backed health care coverage.

As explained by individuals familiar with the situation, OMIG's third-party vendor, HMS, has farmed out work with another firm, Datamatics, which in turn has operations overseas. An ancillary facility in Chennai, India, has actually handled many of the functions, according to a person associated.

The function requires using patients' files in order to discover if they have insurance coverage that needs to be utilized before Medicaid is deployed. The third-party discovery is among OMIG's best ways in order to prevent erroneous billings to Medicaid.

Under an arrangement entered into at an earlier time this year by HMS, foreign nationals may well access the full name, address, Social Security number, dates of birth and insurance companies associated with individuals within New York's system, according to people involved in the issue. The expense when employees in Texas did the third-party services was approximately $1.25 per beneficiary. The expense for the Indian company is about 15 cents per beneficiary, an individual associated with the system stated, adding that hundreds of jobs at HMS have definitely been cut as a result of the outsourcing.

The Times Union questioned OMIG representatives regarding the outsourcing in late May, and the department promised to address the concern. As of Friday, OMIG officials were resistant to explain what is being undertaken, although HMS and OMIG are currently up in arms over the subcontracting, according to a person involved.

Wanda Fischer, an OMIG spokesperson, said her agency deals with HMS "but does not have a relationship with Datamatics.".

"OMIG takes the security of personal data very seriously," she stated. "OMIG is investigating the matter.".

Fischer's director, Deputy Medicaid Inspector General Mark Hennessey, added: "OMIG works to ensure the security of personal data. As this is an ongoing investigation, we can not comment on the matter.".

Francesca Marraro, an HMS spokesperson, claimed the information utilized to assist New York track down third-party insurance providers is "physically located" on safe and secure systems in the United States. She said she did not know if firms in other countries are able to accessibility it.