Fraud Prevention And Detection

Latest Headlines

Latest Headlines

For fraud enforcement, strength in numbers takes on a double meaning

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. 

Iowa governor defends companies selected to manage Medicaid program

Iowa Gov. Terry Branstad is defending the companies selected to manage the state's $4.2 billion Medicaid program, despite reports that all four have been involved in high-priced fraud settlements, according to the  Des Moines Register.  

Health insurer mergers could impact SIUs in an evolving fraud climate [Q&A]

The more things change, the more they seem to stay the same. That's particularly true when it comes to the cyclical nature of healthcare fraud, said Jack Price, former chief security officer and special investigations unit director for Blue Cross Blue Shield of Tennessee in an exclusive interview with  FierceHelathPayer: Antifraud.

Healthcare data hacks: The next great conduit to fraud

Cybersecurity is emerging as a contentious but important topic for a number of industries around the country. For healthcare, the consequences of data breaches that expose beneficiary information can be devastating, particularly for the beneficiaries who often have no recourse to fight off claims made under their name. As 2015 has become the year of the data breach, it's becoming clear that improved cybersecurity is imperative to fraud prevention.   

Highmark anti-fraud efforts saved $100 million in 2014

Anti-fraud efforts involving data analysis and coding investigations saved Highmark Inc. more than $100 million last year.

DOJ-HHS anti-fraud effort recovered $3.3 billion in 2014

More than $27.8 billion has been returned to the Medicare Trust Fund since the inception of the Health Care Fraud and Abuse Control Program in 1997, according to a  new report  from the Departments of Justice and Health and Human Services. The program recovered $3.3 billion of taxpayer money in the 2014 fiscal year alone.

Public-private healthcare fraud partnerships aim at prevention

For decades, fighting healthcare fraud has involved a "pay-and-chase" mentality. Recently, though, the focus has started to shift to prevention.

How a strategic approach to data will advance fraud prevention in healthcare

Information technology is paving the way for advanced data analytics, but organizations need to do more to learn from that data, identify abnormal trends and progress to the next level of premptive fraud prevention. 

Get 'Fierce' about fighting insurance fraud, waste and abuse

Welcome to FierceHealthPayer: AntiFraud, the newest publication from FierceMarkets, created to support fraud prevention and detection professionals in the health insurance industry. Have you noticed...