Continue reading Continue reading
Logo
twittergoogle_plus

Are You Prepared to Prevent Fraud and Detect It?

In 2017, there was a median loss of $1,185,990 for health care fraud offenses. Per the Centers for Medicare and Medicaid Services, in 2016 health care spending reached $3.3 trillion. It was also estimated that hundreds of billions of dollars were also lost to health care fraud annually. Is your medical practice prepared to handle health care fraud prevention and detection? Do you know the first steps to take? Do you recognize the different options you have to detect fraud? You need a fraud and abuse management system in place that utilizes healthcare fraud software.

How Does Healthcare Fraud Happen?

Healthcare fraud occurs when an individual that is insured, or a provider of health care, offers misleading or false information to insurance companies so the health insurance company will pay for benefits that are unauthorized to said policyholder, party, individual or health care provider. As a medical care employer, you may experience both or one of those instances where employees commit insurance fraud, or fraudsters are actually victimizing you.

How Does Fraud Impact Your Employees and Business?

Medical fraud detection such as healthcare fraud software is essential when it comes to detecting fraud. Fraud impacts businesses as well as employees negatively. There are many ways this type of fraud causes negative effects. The impact can include reduced benefits with higher insurance premiums. This makes a lot of coverage unaffordable and may even force you to offer fewer benefits to employees including vision and dental coverage.

No one wants to pay higher deductibles and copays either. For you to continue to offer great insurance coverage to employees, you may have to make it more affordable for your business and offer employees higher deductibles and copays, which in turn will put a strain on finances for employees. There are many negative ways fraud can impact your business and therefore you and your employees.

What Exactly Is Fraud?

There are many different types of healthcare fraud. Some of the most common allowing another individual to use your insurance cards or identity to get health care. Adding an individual that is ineligible to an insurance policy by using false information is considered to be fraud. Using benefits to purchase prescriptions that are not prescribed for provided is another issue. If a person is not removed from a policy when the are no longer eligible, fraud is committed. Fraud is visiting several doctors to get numerous prescriptions, or claiming to have been injured from an accident that was staged so you get medication, care or even reimbursement. It is also considered fraud if a claim is exaggerated.

Healthcare Fraud Software Can Break the Chain of Abuse

It is essential that you are able to break the chain of abuse when it comes to fraud prevention and detection. Prospective fraud can be caught using the latest healthcare fraud software. A hybrid software system can perfectly augment any existing anti-fraud initiative you already have in place. Proprietary detection software that has been developed using real-world investigation experience is the idea medical fraud detection software you need.

The Benefits and Features of Healthcare Fraud Software

It is imperative that your business is about to mine data t expose possible abuse and fraud. This can include aberrant patterns and billing trends. Your data needs to be mined so hidden relationships and patterns are revealed that could be causing potential abuse, waste and fraud. The overall idea is to prevent lost expenditures for your business and being able to remain compliant. Let the anti-fraud professionals introduce you to fraud software that will exceed your expectations and keep your business safe.

Leave a Comment