Healthcare Fraud Control Articles
Most healthcare organizations don’t know how much they are losing to fraud. They only know how much fraud they’ve found, but the real cost of fraud remains hidden. We just know about the tip of the fraud iceberg.
How can you find out how fraud is impacting your organization? You can measure. Payment accuracy measurement can help you estimate the impact of fraud and other improper payments.
Does more medical spending result in better health? Researchers knew that differences in medical spending between regions (which vary by as much as 200%) are not explained by differences in prices, nor differences in health or socioeconomic status. Instead, they are related to differences in the quantity of medical services provided and in the number internists and specialists.
A pedestrian saw a man under a streetlight looking for something and asked, “Are you having any luck?”
“No,” said the man, “I’ve been looking for hours.”
The puzzled pedestrian asked, “Why are you still looking here?”
“This is where the light is.
Too often in fraud control we only look in the light. We look for patterns other people have already found. We look for patterns that are so obvious, only the most unsophisticated fraudsters would bother with them.
When we create healthcare policy, we spend months thinking about how the policy will change the behavior of providers and patients. Ninety-nine percent of the time we’re thinking about honest providers and patients. But what about the people who aren’t honest? Are we handing them an easy opportunity for fraud?