To fundamentally change how healthcare fraud is rooted out, health insurance companies should conduct robust screening of providers in their network.
Fraud prevention at Aetna, which focuses on health IT to root out potential fraudsters, has yielded very strong results for the insurer--a 15:1 return on investment.
One of the most important steps that WellPoint takes to combat healthcare fraud is assemble a strong, experienced team of employees with backgrounds in various law enforcement areas, which then can be leveraged to help ensure criminals are prosecuted.
Fraud recoveries return about 20 cents on the dollar; not paying fraudulent claims nets dollar-for-dollar savings. How do insurers guard against those who plot to take the money and run? Experts reveal that not all anti-fraud practices must be expensive to be effective.
When it comes to fraud prevention and detection, Health Care Services Corp. (HCSC) takes a hard line against criminals. "Our goal is to prosecute fraudsters," said Sharon Green, senior manager of special investigations for HCSC-owned Blue Cross Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas told FierceHealthPayer.
Under A.B. 2138, which passed the California Assembly last week, health and disability insurers would be assessed 20 cents per insured person, up from the current 10 cents per person.
Verizon is offering private health insurers and government agencies involved in healthcare the same fraud prevention solution that it has already piloted for the Centers of Medicare and Medicaid
Rep. Marsha Blackburn (R-Tenn.) wants insurers' fraud prevention efforts, such as investments in technology, to count as quality improvements for calculating the medical-loss ratio (MLR) that health