Public Service Clinics Topics
Provider Review and Education, Health Services Analysis, Washington State Dept. of Labor and Industries #1
Agency/Program Overview
The mission of the Department of Labor and Industries is to support the state's economic well-being by protecting the safety of Washington's
workers, providing benefits to injured workers and ensuring fair wages and quality industry services.
These responsibilities include enforcing the Washington Industrial Safety and Health Act (WISHA); managing the state's workers' compensation system;
providing safety and health consultations and information; enforcing wage-and-hour, child labor and family leave requirements; managing the
state's crime victims' compensation program; registering contractors and apprentices; inspecting electrical work, elevators, boilers and
factory-assembled structures; and issuing licenses for certain skilled trades.
Looking specifically at the health care received by injured workers, our department is the eighth largest insurance provider in the U.S. and is a
national leader in workers’ compensation health care.
Specific Research Question
Given our team’s mission to insure medical bills are paid properly and injured workers receive quality medical care, are we achieving the best results and how can it be improved?
Additional Project Background
To provide the health care needed by injured workers, the department has over 60,000 health care providers delivering health care. L&I processes over 4,000,000 health care bills per year and pays these providers over $6,000,000 per year for their services.
However, industry estimates that 3-10% of all healthcare spending is lost to healthcare fraud and abuse. Based on this estimate, L&I loses between $18M-$60M to healthcare fraud and abuse per year. Additionally, ViPS, a new audit software application, has identified leads totaling over $1M of inappropriate payments.
L&I has limited resources to address this issue. There are currently 5 FTE auditors available to work on this issue. Together, these auditors complete approximately 100 audit reviews per year. The audit period is typically 2 years and is done on retrospective basis. A typical audit can take between 3 weeks and a year to complete. Given these limitations, the auditors identified $2.8 million in inappropriate payments for the time period 10/1/08-9/30/09.
Key Steps
Student would interview audit staff and review current audit process.
Conduct literature review and comparative analysis of other similar organizations.
Conduct analysis of current process, to include statistical analysis of available billing data to determine return on investment and program effectiveness.
Provide recommendation on how to improve program’s processes and method to determine ongoing ROI.
Additional Research Resources
In addition to the key steps listed above, the student would have access to agency staff and department data bases. Work space and computer support would be available as well.
If you have any questions about this topic or would like more information, please contact Gary Walker, Manager.