Robin Mathias's blog
In this month’s issue:
- Make Fraud Control Everyone’s Job
- Wheelchair Fraud Update
- Let’s talk about Data Mining
- Upcoming Events
Large OH Health Plan Adds the Latest Prevention and Detection Technology in Its Battle Against FraudSubmitted by Robin Mathias on Sat, 06/19/2004 - 10:33am. News and Commentary
Wheelchair fraud is in the news again, as two men in Texas pleaded guilty to submitting fraudulent claims to Medicare for power wheelchairs. In the past year, the Federal government has taken many steps to crack-down on power wheelchair fraud. In February 2004, the Deptartment of Justice announced 11 arrests in Texas as the result of Operation Roll Over. In September 2003, the Centers for Medicare and Medicaid Services (CMS) announced Operation Wheeler Dealer, a ten point plan to curb wheelchair fraud in the Medicare program. At the end of April 2004, CMS announced new payment guidelines to make sure that people who need wheelchairs get them and people who don’t, don’t.
This New York Times article reminds us that we have to be careful how we interpret cancer screening results. Early detection of cancer can lead to unnecessary interventions. The study showed that 15% of men with PSAs below 4 had cancer. The study could lead some doctors and patients to conclude that a biopsy makes sense, even with low PSA. However, the article also says:
The Month’s Report:
- Ten Steps to Stop Healthcare Fraud
- Fraud Control Toolbox
- Updated Bidding Opportunities
- Public Appearances
Fraud is a serious problem that affects every healthcare system. Each health plan loses from 3% to 30% to fraud, waste and abuse. Reducing fraud losses is one of the few ways that a health plan can cut costs without hurting their members or providers. Investment in fraud control typically saves $6 to $12 for every dollar spent, yet health systems have not invested in the level of controls that will effectively stop fraud. Check out these ten steps that will help you stop fraud.