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Bounty Hunters

McClatchy reports: Medicare auditing program could end up costing U.S. taxpayers

WASHINGTON — U.S. taxpayers will end up paying millions of dollars in commissions to an Atlanta-based auditor even though the firm’s wholesale rejections of Medicare claims from California rehabilitation hospitals are now being reversed on appeal.

The rulings by administrative law judges for the Office of Medicare Hearings and Appeals will restore money withdrawn from California hospitals, some of which are suffering financial hardships and have trimmed services to Medicare patients as a result of the reviews.

But PRG-Schultz International, which is paid as much as 25 to 30 cents for each dollar of Medicare spending it identifies as wrongly paid, can keep its bounty as long as its findings are sustained through the first two levels of administrative review. The reversals are coming in the third level, the first time PRG-Schultz’s decisions are being looked at through independent eyes in trial-like settings.

If you pay fire departments based on the number of fires they put out, you get a lot of fires. I you fund plice departments based on the number of tickets they write, you get speed traps.

The people who came up with this concepts are dumber than a bag of rocks, or members of the Hedgemony, which is the same thing.

10 comments

1 whig { 09.17.07 at 1:08 am }

And if you pay military contractors based on their cost plus…

2 Steve Bates { 09.17.07 at 11:10 am }

I remember a Dilbert cartoon in which the boss offered a bonus to programmers for each bug found and fixed…

3 Bryan { 09.17.07 at 11:29 am }

Whig, there isn’t enough paper in the world to contain what I think about “cost plus” contracts and their theft from the Treasury.

Oh, yeah, Steve, that would really lead to a success programming effort 😈

4 whig { 09.17.07 at 12:07 pm }

Steve Bates, maybe that’s my problem. I never had bugs.

5 whig { 09.17.07 at 12:09 pm }

Inoptimal code? Sure. All the time.

6 Bryan { 09.17.07 at 3:28 pm }

I’ve had more than a few “features” over the years, but I’ve never released anything with actual bugs in it. The “bugs” that users found were generally issues that were never discussed when the contract was written.

7 whig { 09.18.07 at 12:01 am }

If one person designs and codes, there is no excuse for bugs.

8 Bryan { 09.18.07 at 12:44 am }

Designs? You’ve worked somewhere that allows designs? In most shops you’re lucky if they can provide you with a cogent description of what the customer wants.

I always felt guilty teaching students the way software is supposed to be created, knowing the reality that awaited them.

In too many places today they think you are slacking off if you aren’t typing code. They want things created on the fly and too much software shows the effects. The rumor is that OOP has eliminated the need to plan and design a solution – you simply drag and drop modules.

9 whig { 09.18.07 at 2:54 am }

I tend to design bottom-up, as needed. I’m not a flow charts guy. OOP and CASE are two separate things. I’m mainly procedural but I can handle objects fine, and event-driven architectures are absolutely better than polling. To do this well requires threads. Good design begins with choosing the right language and tools for your project.

I haven’t worked for an employer in a long long time. I do occasional projects, and they are mine to do, so I don’t have to deal with incompetent programmers. I can’t work well with them, because they are too much of a hindrance and slow me down more than help.

Give me a couple or three really good programmers, though, and it’s pretty cool to bounce off one another.

10 Bryan { 09.18.07 at 11:35 am }

You work in a very small environment, because most work is done under unrealistic time pressures with the time eaten up in contract negotiation and the project given to the IT department almost at the last minute. There has been an attitude for too long to get something out there and we’ll fix it when the bug reports start coming back. There seems to be plenty of time to fix things, but not enough time to do it right.