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For decades, fighting healthcare fraud has involved a "pay-and-chase" mentality. Recently, though, the focus has started to shift to prevention.
Even Medicare fraud investigations are not immune to political pressure, according to an investigative article from the Wall Street Journal. The newspaper details instances in which governors and state representatives have interjected themselves into fraud investigations, blocked payments, and prepayment reviews.
FierceHealthPayer: Anti-Fraud talked to Michael E. Little for expert advice on how special investigations units can improve their anti-fraud casework. Little is a senior manager in the forensic practice of Deloitte Financial Advisory Services, LLP in Philadelphia.
Though it's often hard to say with certainty if someone is lying or telling the truth, recent news describes questioning strategies and clues fraud investigators can use to improve their chances of exposing lies in investigative interviews.
Growing numbers of providers are choosing to run cash-only practices to subvert health insurance middlemen, and fraud and abuse concerns contribute to the attractiveness of this business model.
Whether or not they've committed wrongdoing, payers are increasingly becoming the targets of significant fraud investigations. So it pays to prepare financially and operationally for this possibility. FierceHealthPayer: Anti-Fraud interviewed Kirk J. Nahra, J.D., a partner in the Washington, D.C. law firm WileyRein, to bring readers expert advice on this topic.
The Obama Administration's crackdown on healthcare fraud has led to a record $2.5 billion being recovered from industry-related wrongdoing during the most recent fiscal year, reports USA Today. "Our
It looks like last year was a serious downer for the Blue Cross and Blue Shield plans, which lost a collective 40.9 percent in income for 2008, as compared with the previous year, struggling with
Press Releases
- New NCQA eMeasure Certification Program to Expand HIT Data Use in Measure Reporting
- Leidos Defense Healthcare Management System Modernization contract
- More than $38 million awarded to improve coordinated health information sharing in communities across America
- Covered California Announces Rate Increases for 2016; Consumers Should Consider "Hidden Premium" From Narrow Networks, High Deductibles, When Shopping For Insurance Says Consumer Watchdog
- Most Wired Hospitals Focus on Security and Patient Engagement
- More Press Releases
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