A changing regulatory environment and an evolving payer marketplace is driving growth in fraud, waste and abuse prevention and detection tools, provoking more companies to offer services that supplement existing software.
For decades, fighting healthcare fraud has involved a "pay-and-chase" mentality. Recently, though, the focus has started to shift to prevention.
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.
In the second year of implementation, the Fraud Prevention System (FPS), established by the Centers for Medicare & Medicaid Services, reported $54.2 million of actual and projected savings to the Medicare fee-for-service program, according to a report released today by the Office of Inspector General.
Promoting health among members can help lower claims costs and improve overall health, reports the International Travel & Health Insurance Journal. Author David Healy outlines a few key findings as to how the international private medical insurance (IPMI) industry handles claims-related costs.
Using predictive modeling to fight fraud, the Massachusetts insurance exchange recouped $2 million in six months and avoided paying hundreds of thousands of dollars inappropriately, according to technology research and assessment firm GCN.
The U.S. Department of Health & Human Services has allocated hundreds of millions of dollars to rooting out and preventing fraud in Medicare and Medicaid, but a new report shows HHS fraud prevention programs might not be effective.
Many people do nothing to prevent medical identity theft, largely because they don't know how, according to a new survey report from the Ponemon Institute. It estimates the number of victims at...
Payers sift through and analyze millions of provider claims, working to prevent fraud and cut costs. They rightly consider these claims as valuable points of information that help identify...
Efforts to crackdown on Medicaid fraud have led to positive results in New York and Missouri, where the states collected hundreds of millions of dollars in settlements and obtained a variety of criminal convictions.