Most U.S. insurers measure the performance of special investigations units, but their methods for measuring SIU success vary, according to results from the Coalition Against Insurance Fraud's first-of-its-kind benchmarking study.
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Insurers should consider many factors before taking legal action to get recompense in fraud cases, attorney Frank S. Goldstein advised in a Claims Journal article, including corporate priorities and projected expenses for each case.
Law enforcement officials estimate that fraud drives up to 10 percent of Medicare's annual spending, but recovering that money and preventing more losses can be a David-and-Goliath fight, according to reports in the New York Times and the Wall Street Journal.
The link between unnecessary surgery and alleged healthcare fraud made headlines last week in cases against a Virginia dermatologist and an orthopedic surgeon in Ohio.
A long investigation by New York's Medicaid fraud control unit, with the assitance of an elderly "spry spy," led to four arrests and a $6.5 million settlement with Brooklyn's Northern Manor Adult Day Health Care Program, according to an announcement by state Attorney General Eric T. Schneiderman.
Up to 310,000 Affordable Care Act health plan enrollees will lose coverage unless they supply proof of citizenship or legal residency in the United States by Sept. 5, according to The Wall Street Journal.
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Most state-run health insurance marketplaces are still stuck focusing on technical challenges, but those that want to get out front should be focusing on raising quality of care, according to a new Commonwealth Fund blog.
Guest post by Jason A. Wolf, Ph.D., president of The Beryl Institute, where he specializes in organizational effectiveness, service excellence and high performance in healthcare. I shared in...