A reliable method of verifying patient visits
with authorized providers
Medical insurance fraud is a very serious and costly problem that effects every patient and every taxpayer across our nation. With the dawn of the Affordable Care Act millions of new patients will be incorporated into the insurance data bases of both private and government sponsored insurance carriers. Protecting these transactions and ensuring a minimization of fraud will be essential to keeping costs down and making the system financially sound.
The May 31, 2014 issue of The Economist highlighted the problem in the following fashion:
”Health care is a tempting target for thieves. Medicaid doles out $415 billion a year; Medicare (a federal scheme for the elderly), nearly $600 billion. Total health spending in America is a massive $2.7 trillion, or 17% of GDP. No one knows for sure how much of that is embezzled, but in 2012 Donald Berwick, a former head of the Centres for Medicare and Medicaid Services (CMS), and Andrew Hackbarth of the RAND Corporation, estimated that fraud (and the extra rules and inspections required to fight it) added as much as $98 billion, or roughly 10%, to annual Medicare and Medicaid spending—and up to $272 billion across the entire health system.”
This estimate of $272 billion has done nothing but increase over the past 2 years and is expected to continue a steady climb in the years to come. Such financial loses are compounded by numerous instances of delays in patient treatment by a healthcare industry which sees these persons are having already maxed out their benefits or being party to a fraud scheme (often mistakenly) This results in delays in definitive treatment which later proves to be EVEN MORE COSTLY as a patient’s clinical condition worsens and the treatments required by these patients become increasingly complex and costly.
Clearly the protection of policyholders and providers in a fast, simple real-time process is the key to preventing fraud.
Sophisticated healthcare fraud schemes rely increasingly on falsified records in addition to bogus identification credentials. Current fraud investigation procedures identify abusive billings through retrospective analysis AFTER it has paid the claim. These moneys are often unrecoverable at this point. Even with some front end safe guards, criminals are increasingly sophisticated in detecting and circumventing these procedures.
Certainly the PREVENTION of fraud BEFORE it happens will be critical for reining in the skyrocketing cost of health insurance.