January 2014—Dr. Krista K. Laursen ’13, a career scientist and project manager, likes a challenge. That’s why she chose to write her doctoral study on Medicaid fraud and abuse, an entirely unfamiliar subject. “I like challenging myself to step into a field where I haven’t done a lot of work before,” she explains.
If you look at Dr. Laursen’s career history, you’ll find a similar pattern. In 2012, she accepted the role as lead project manager and chief operating officer (COO) for NEON Inc. in Boulder, Colo., precisely for the change in direction it offered. The continental-scale observatory measures the causes and effects of climate change, land use change, and invasive species on U.S. ecosystems. Her role as project manager and COO allowed her to pivot within the scientific community to focus on biological sciences. Prior to this, she’d spent 20 years at the National Center for Atmospheric Research, managed a project to build a supercomputing center in Wyoming, and studied pollutant emissions from forest fires.
For her doctoral study, she wanted to go even further afield. In recognition of her efforts, the Doctor of Business Administration (DBA) graduate was awarded Walden University’s 2014 Frank Dilley Award for Outstanding Doctoral Study for her research, Leadership Strategies and Initiatives for Combating Medicaid Fraud and Abuse.
The topic arose when her faculty member, and later her committee member, Dr. Jon M. Corey suggested she look at Medicaid. When she dove into the literature, she was shocked by what she found: An estimated 3-10% of the $2 trillion spent annually on healthcare in the United States is lost to fraud.
“That stat sticks in my mind,” Dr. Laursen says. “It’s staggering.” Not only did she want to answer how this happens, she also wanted to explain why it persists. To make her study more manageable in scope, she narrowed her focus to Arizona and interviewed healthcare leaders in the state.
Examining Her Findings
Through her qualitative study, including the literature review and interviews, she found that fraud and abuse is prevalent. Secondarily, she found a lot of ambiguity: Regulatory and organizational responses to identified problems actually impede future detection of fraud and abuse in the Medicaid system. This doesn’t boil down only to errors on electronic reports (although those are included), it also includes a much larger problem: Falsified reports that can be submitted by healthcare providers.
To highlight this issue, Dr. Laursen points to the pay-and-chase system used by Medicaid. Payments have to be made in a short period of time, which doesn’t allow processing staff to check the legitimacy of charges before processing payments. States are forced to review payments after they are made, which also leads to slower reviews that are fewer in number, allowing fraud to continue unchecked.
“The healthcare leaders I interviewed feel very strongly that we need to move from national- to state-controlled Medicaid,” Dr. Laursen explains. Their thinking is that if you create smaller state-run programs, they will be easier to police, even if policies about how the program is administered aren’t changed immediately. Smaller state-run systems would allow leaders “to create more manageable Medicaid systems and empower states by giving them the initiative to supply creativity and innovation,” she continues.
Although this article presents only a sliver of the 14 major findings in her doctoral study, Dr. Laursen hopes to share all of its outcomes with healthcare leaders to effect change across the industry. Additional findings point to the benefits of increased use of technology, attention to privacy concerns, and a move to a block-grant program design.
As unorthodox as her research may seem, it’s positively influenced her work at NEON. “Over the course of the study, I had to acquire a different set of skills, including deep listening skills that allow me to be objective and think carefully about other people’s perspectives and how to assimilate them,” she says. “Working on this study was one of the most difficult things I’ve done, but it taught me to listen for nuances and learn how to interpret them, which has really helped at work. I concluded recently that one of the most important things I can do as a manager and leader is step back, get out of the way, and help others find a solution.”
About the Award
The Frank Dilley Award for Outstanding Doctoral Study is bestowed annually upon a Walden student whose dissertation or doctoral study is judged as meeting the highest standards of academic excellence. It honors Dr. Frank Dilley’s singular academic contributions to higher education and, specifically, his dedication to Walden’s academic programs. An active contributor to the university programs and, in particular, to residencies, Dr. Dilley personifies Walden’s innovative spirit.
Read more about the Frank Dilley Award and past recipients.