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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Increasing health IT adoption, global care mandates and venture capital investments will help to push the health analytics market to 25 percent annual growth over next five years, according to a new report.
The Senate Appropriations Committee has directed the ONC's Health IT Policy Committee to submit a report on the technical, operational and financial barriers to information-sharing among electronic health records systems--what it calls the "information-blocking problem"--and what should be done to combat it. The order comes in a draft budget report that recommends a $61.474 million budget for the Office of the National Coordinator for Health IT rather than the $74.688 million it had requested.