Touting accessibility and affordability, telemedicine is poised to make a huge splash in the healthcare industry in the coming years. The global telemedicine market is expected to reach 7 million patients worldwide by 2018, fueling an 18 percent growth rate by 2020. Although most telehealth arrangements are exempt from anti-kickback laws, broader coverage, particularly at the federal level, could push fraud and abuse considerations to the forefront of a burgeoning industry.
Predictive analytics is the hot new buzzword in healthcare. Now, it is changing the way payers to identify instances of fraud, waste and abuse. Increasingly, both public and private payers are turning to data analytics to identify high risk fraud trends, said Andrew Asher, senior fellow and director of data analytics at Mathematica in an exclusive interview with FierceHealthPayer: AntiFraud. However, payers like Aetna are gradually realizing the full impact of using healthcare claims data to accurately predict fraud schemes.
Strength in numbers. It's a tried and true adage that's so universal that it's ben used by high-ranking generals as a wartime strategy, or a pack of disgruntled kindergarteners standing up to the schoolyard bully. For those charged with fighting fraud, it's a maxim that holds true in more ways than one. Data analytics provides the building blocks for fraud detection, but increasingly, states are forming their own healthcare fraud task force to employ a more simplistic approach to fraud enforcement. Read more...
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The former chief financial officer at a Southern California hospital and two orthopedic surgeons are among five individuals arrested and charged with participating in a widespread fraud scheme that lasted eight years and led to more than half a billion dollars in false claims.
An insurance broker from a popular Vermont ski destination will spend three years in prison for stealing millions in insurance premiums that were supposed to be transferred to Aetna.
As improper payment rates increase across the board, federal officials are targeting areas of healthcare that are particularly vulnerable to fraud, including prescription drug schemes involving non-controlled drugs and high-priced specialty drugs, according to reports from the National Health Care Anti-Fraud Association's annual conference.
After agreeing "in principle" to settle kickback allegations last month, Novartis finalized the $390 million deal, ending a drawn out legal battled that has led to nearly half a billion dollars in recoveries, according to a release from the Department of Justice (DOJ).
Providers in Atlanta are raising concerns about the state's approach to fraud enforcement, citing multiple cases in which the state has levied heavy fines against facilities for making small clerical errors, according to WSB-TV 2 in Atlanta.
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After failing to devise a way to replace the state's managed care organization tax, California lawmakers are facing a $1.1 billion hole in next year's health budget, Kaiser Health News reports.
Two of the men Pamela Wible, M.D., a family practice physician, dated in medical school took their own lives. Eight physicians in her small town committed suicide. Writ large, physician suicide is a public health issue: More than one million patients lose their physicians each year because those physicians take their own lives. In a recent interview with Christine Sinsky, M.D., from the American Medical Association, posted on the KevinMD blog, Wible offered several steps the medical community can take to help prevent additional physician suicides.