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 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.
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.
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.
Anti-fraud efforts involving data analysis and coding investigations saved Highmark Inc. more than $100 million last year.
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.
For decades, fighting healthcare fraud has involved a "pay-and-chase" mentality. Recently, though, the focus has started to shift to prevention.
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.
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...