Home Care Fraud is on the Rise

by IBM

The shift to delivery quality health care at home is on the rise, but so is the potential for improper activity. More insight is need to ensure quality of care while pro-actively detecting unusual or inaccurate pattern of service and payments.

The Growing Problem of Medical Identity Theft

by IBM

Medical identity theft (MIT)is a fast growing fraud problem spurred by the advancements in healthcare services coupled with the explosive use of technology to deliver quality care. The healthcare industry could learn a trick or two from the Financial Services industry on ways to thwart fraudulent risk and cyber attacks.

The Pitfalls of Healthcare Portals

by Experian Health

Online patient portals have been built to provide the ultimate self service experience while engaging patients more fully in their care. Integrated into multiple internal systems, portals offer convenient access to personal information: Social Security number (SSN), date of birth (DOB), address, insurance information, prescription information and extensive medical records. This one-stop shop for medical identities and health records is exactly what makes healthcare portals particularly attractive to cybercriminals. While lucrative for criminals, a portal compromise can be extremely costly to healthcare organizations, affecting finances and their reputation.

Public Records for Health Care

by LexisNexis

The United States now spends about $2.6 trillion annually on health care (17.5 percent of GDP) and with the reform initiatives under the Affordable Care Act (ACA), the number of Americans covered and the amount spent will grow dramatically, potentially leading to even greater fraud, waste and abuse in the system.

Revolutionizing FWA detection with a fully integrated software solution - FWAShield

by Healthcare Fraud Shield

Healthcare Fraud Shield is a provider of dynamic fraud, waste and abuse detection software solutions that have dominated the complex financial services industry over the past fifteen years. Our suite of products introduces several new technology applications to the healthcare industry that will revolutionize cost reduction opportunities. Read more to find out about our products and services.

Payment Policy Optimization: Blending Analytics with Rules to Prevent Wasteful, Abusive and Fraudulent Healthcare Spending

by McKesson

Curtailing the massive drain caused by FWA in healthcare has never been more important. New, more complex payment models are on the horizon, including bundled payments for episodes of care, and greater emphasis is being placed on payment for outcomes. In 2014, providers and payers will also be adjusting to ICD-10 coding. Experience has shown that each novel payment arrangement or code change presents new opportunities for confusion and abuse - for example, inadvertent or purposeful upcoding. This white paper by McKesson's Jim Evans looks at blending analytics with rules to prevent wasteful, abusive and fraudulent healthcare spending.

Case Study: Humana's Fight Against Fraud

by Verisk Health

"Humana wants to lead the industry in stopping fraud up front," says Jean Sexton, Area Director for the Humana Special Investigations Unit (SIU). Sexton asserts Humana's commitment to fighting fraud is long-standing and proactive. Rather than relying on data mining flags to simply stop damage from getting worse, Humana aims to eliminate fraud. Since implementing Verisk Health's fraud solutions, referrals to the SIU have increased steadily. Humana's referrals are up thirty percent from a year ago. According to Sexton, the dollar amounts decreased as the number of cases increased. "We're catching it up front so we're reducing waste caused by fraud."