Harnessing the power of crowdsourcing is a fresh idea proposed to supplement tried-and-true methods of identifying health insurance fraud.
Does your company have a strategic plan in place for anti-fraud training and communications? It's an idea worth considering. Because when it comes to detecting health insurance fraud, waste and abuse, people are opportunities.
If we accept that a small subset of the provider and customer base commits fraud, it follows that most health insurance stakeholders are honest. Compelling calls to action can rouse them to help tackle a problem that threatens the healthcare system.
But too often we compartmentalize training and communications. Payers release an annual e-training, for example, or add a special investigations page to corporate websites. These efforts are helpful but isolated; they're like crossing a requirement off a to-do list. Read more...
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FedEx Corporation, a Memphis-based global courier delivery company, was indicted last week for shipping drugs for illegal online pharmacies. A federal grand jury charged the company with 15 counts of conspiracy to distribute controlled substances and misbranded drugs and drug trafficking.
States are exploring the use of smart cards to verify Medicaid recipients' identities and foil fraud, according to NJ.com opinion piece.
Data aren't always accurate, complete or reliable, so fraud fighters should view them with awareness that "the quality of the information upon which the government relies has often been in doubt," according to Forbes.
Scams related to healthcare services by unlicensed individuals highlight not only fraud-related financial loss but also patient safety risks. Cases presenting this combination of issues should be a top priority for investigators.
Halifax Health--a Florida hospital system enmeshed in a high-profile whistleblower lawsuit--has spent $22.8 million in legal fees to defend itself through lawyers charging up to $935 an hour, The Daytona Beach News Journal reported.
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The Centers for Medicare & Medicaid Services, evidently concerned about some of the negative outcomes involving intrusive pop-up clinical decision support alerts, has issued a tip sheet and answers a FAQ to clarify that the Meaningful Use incentive program is not limited to this type of notification.
Forthcoming legislation set to be introduced by Rep. Mike Thompson (D-Calif.) looks to expand Medicare coverage for telemedicine beyond what the Centers for Medicare & Medicaid Services proposed earlier this month in its update to the Medicare Physician Fee Schedule.