The federal government will pay Woolworths-backed Quantium Health another $9 million over the next year for tools to detect suspected instances of Medicare claims fraud by health providers.
The Department of Health and Aged Care entered the contract for ‘data analytics services to support health provider compliance’ this month, extending its existing relationship with Quantium Health.
Quantium Health is jointly owned by the data analytics firm Quantium Group, which is majority-owned by the Woolworths Group, and South African insurer Discovery Limited.
The company first began providing data analytics services to support health provider compliance in June 2019 under a now-expired $19.6 million contract that climbed to $28.6 million last year.
It also currently provides “health services” under a $53.1 million contract (originally worth $9.4 million) and “Covid-19 modelling” for $3.3 million, both of which will run until the end of 2023.
A spokesperson for the department told iTnews that the data analytics tools provided under the contract will “enable compliance staff to detect possible non-complaint Medicare claiming”.
The contract covers “the development, maintenance and support” of the tools until the end of June 2023.
“The service supports the Medicare provider compliance function within the department,” the spokesperson added.
Medicare provider compliance has ramped up since December 2019, when controversial legislation designed to better detect fraudulent or incorrect claims passed through parliament.
The Health Legislation Amendment (Data-Matching and Other Matters) Act helps the government to identity and take action against health providers that make inappropriate Medicare claims.
In 2019, the value of Medicare and other health services claims estimated to be fraudulent or inadvertently non-compliant each year was estimated at almost $2 billion.
Approximately $42.6 billion was spent through the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and Child Dental Benefits Schedule and Practice Incentive Program in 2020-21 [pdf].
Woolworths took a controlling stake in Quantium for $223 million in April 2021, lifting its share of the investment to 75 percent.
In taking a controlling stake, the retailer planned to create a joint business called Q-Retail consisting of its data science and advanced analytics team and secondees from Quantium.
As revealed by iTnews last week, Woolworths has now rebranded Q-Retail as wiq, and is in the process of assembling a team of ex-consultants to run a transformation of its analytics operations.
The Commonwealth Bank also uses Quantium data capabilities through a joint venture, CommBank iQ.
