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Healthcare and Entitlement Programs

One focus area for The University of Texas Center for Identity is healthcare and entitlement program abuse. Identity authentication is the single most critical factor in mitigating losses due to provider and recipient abuse and fraud. The Center and The University of Texas are uniquely positioned to address this identity issue. With some of the most highly ranked academic disciplines in the United States, such the LBJ School of Public Policy, the Center will draw from University resources to address the multifaceted problems associated with identity management in a public policy setting.

The Center focuses on detecting fraud and abuse from recipients and providers from enrollment assessment through ongoing detection. The primary objective will be to break the "pay-and-chase" cycle – moving law enforcement agencies from primarily a prosecution enforcement model to a more proactive prevention model. The foundational method researched by the Center for fraud and abuse prevention focuses on validating the identity of both recipients and providers, thereby significantly reducing the number of incidents that occur in each entitlement program.

Recent federal legislation has expanded the latitude and tactics available to enforcement agencies, empowering them to intervene earlier in the fraud and abuse cycle. The Center researches various public policy and tactical options for timely intervention. The research will provide the appropriate policy guidelines as well as recommend the relevant best practices to reduce fraud and abuse losses. Policy issues will largely dictate the latitude available for new enforcement methods. For example, policy research is intended to delineate levels of leeway, within the legal framework, that an enforcement agency has in order to intercede at different points in the lifecycle of these entitlement programs.

The Center's research will answer questions such as whether publically available data is not only permissible for use in enforcement, but also whether it is relevant to loss mitigation. Additional research will focus on ongoing risk mitigation related to recency and frequency of medical treatments, and treatment types. In essence, the research will strive to identify the optimal policies and tactics to decide when to enroll both providers and recipients, and then how to monitor ongoing treatments and claims. Resolving questions, such as when is it optimal to adjudicate a medical treatment, will provide best practices for breaking the "pay-and-chase" cycle.

In these economic times, greater efficiency and effectiveness in entitlement programs will be key to closing budget gaps. Research from the Center for Identity at The University of Texas will find best practices to create meaningful reductions in spending without an adverse impact to constituents. Significant savings for taxpayers is a key goal, which given current government deficits, would be welcome news.