Last July, after The New York Times began an investigative series faulting officials for failing to crack down on rampant fraud within New York State's colossal Medicaid program, Sen. Hillary Rodham Clinton (D-NY) proposed combating fraud with new legislation. New York's attorney general, Eliot Spitzer, proposed combating fraud with new incentives for Medicaid whistle-blowers. And Governor George Pataki proposed combating fraud by naming a Medicaid inspector general. It was within this setting of political one-upmanship that an alternative fraud remedy first came to the attention of the nation's media. Only a day after the Times series debuted, the New York State Association of Counties (NYSAC) revealed plans to fight Medicaid fraud by deploying a consulting remedy involving advanced mathematical algorithms.
Whether it was merely fortunate timing or instead the opportunistic reflex of an alert media professional, NYSAC made its announcement only 24 hours after the initial Times article appeared, putting its proposed consulting remedy smack in the spotlight. Hence, NYSAC's algorithm hocus-pocus became ripe fodder for skeptical reporters and bloggers alike.
Before the Sun had set — and the story had reached its 24-hour perishable date — one shadow loomed large across New York State. It belonged not to a lawmaker, whistle-blower, or inspector general, but rather to a mathematician-turned-consultant by the name of Bill Pulleyblank. Now, while some could argue that any one of a number of IBM Corp.'s R&D elite could sport credentials capable of gaining the confidence of a frenzied media pack, it was Pulleyblank's day in the sun, and as such it was his consulting career that spoke volumes that day and has done so every day since. To date, Rockland County, one of the first New York counties to deploy IBM's Medicaid fraud remedy, has identified $13 million in questionable claims due to the work of Pulleyblank and his team.
"We should have done it so long ago, but the capability wasn't there," says Rockland County Executive Scott Vanderhoef, who says that IBM's remedy has already detected that 49 percent of Rockland County pharmacies have some type of "questionable claim," while 19 percent of the county's total Medicaid claims have indications of potential fraud. Based on those figures, he said that if even half of the questionable claims in all of New York State were identified as false, IBM's asset-based consulting remedy could save the state as much as $4.5 billion a year. "Now that we've created this remedy, all sorts of things are happening. First off, the questions become, 'What do we do with this surprising information?' and 'How now do we use it to improve the state's systems across the board?'" says Vanderhoef, who discussed his county's findings at a recent IBM press event. The idea that his latest line of work is helping save taxpayers money is perhaps an amusing notion for Pulleyblank, who up until 18 months ago was ensconced deep within IBM's vast R&D community, where he was credited with — among other things — spearheading the creation of Blue Gene, the world's most powerful supercomputer.
While IBM positioned Pulleyblank's assignment to Business Consulting Services as a milestone in its effort to marry consulting with R&D, its zealous eagerness to conjure up such evidence has at times led skeptics to dismiss the effort as more hype than substance. Nevertheless, few doubt that IBM's Medicaid fraud remedy already deserves milestone status.
As for Pulleyblank, Medicaid fraud represents only a single opportunity for a new asset-based consulting model, one where portions of software and consulting knowledge come together. It's an intersection Pulleyblank seems uniquely qualified to oversee.
At the same time, you can't help but wonder whether this accomplished mathematician — who has at different times in his career served as IBM's Director of Mathematical Sciences (1995–2000) and been in charge of its Deep Computing Institute (1999–2004) — is long for the consulting profession. Then again, perhaps Pulleyblank is finding his consulting work more absorbing than deep computing. Indeed, while consulting is but the latest chapter heading in
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