Commentary: Advanced analytics can combat health care fraud
Health care organizations should look to the credit industry for lessons on how to effectively combat the problem of health care fraud, according to this commentary in Healthcare Informatics. The credit industry has for years used advanced analytics software, which can scan millions of records instantaneously and match transactions with defined patterns and billing norms. Healthcare Informatics (10/2005)
Study: Health IT should prevent fraud
Data profiling, advanced analytic models and rank scoring methods are all possible methods that can be applied to prevent health IT fraud, according to researchers commissioned by Dr. David Brailer, national health IT coordinator, to investigate techniques to prevent health care fraud. Fraudulent claims are estimated to cost up to $170 billion annually. Although the Department of Health and Human Services has not yet developed its detection and prevention plan, "these studies outline methods we can take to start preventing fraud at the doctors' desktop and how we can respond to the threat of cyberfraud during this transition from paper to electronic health," Brailer said. Health Data Management (10/17), eWeek (10/17)
Insurers report uncovering elaborate insurance fraud scheme
A group of health insurance plans, working with the FBI, say they have uncovered an elaborate insurance scam in which thousands of patients from around the country received unnecessary screenings and surgeries in California, for which medical professionals billed more than $1 billion in fraudulent insurance claims. Patients reportedly were given cash rewards or discounts on cosmetic surgery in exchange for receiving unnecessary treatments. The New York Times (free registration) (3/12), The Washington Post/Bloomberg (free registration) (3/12)
Improved software making business more intelligent
Business-intelligence programs are helping executives deal with the mountains of data their increasingly complex customer relationship management and enterprise resource planning programs are generating. Improved computing power is now helping BI programs achieve their promise or producing up-to-the minute reports across a variety of queries. CFO (11/1)
What will consumerism really mean?
This HealthLeaders analysis looks at consumerism and how it has the potential "power to transform the provider industry." Health care providers need to understand that this "new reality" is coming and that it is better to understand it and prepare for it by creating strategies to address rather than ignore it. HealthLeaders Magazine (03/21)
"Managed consumerism" may be next step in CDH
With many employers still adjusting to consumer-driven health care, the system is moving toward the idea of "managed consumerism." The latter combines elements of consumer driven health with managed care principles, and some say the combination is necessary. BenefitNews.com (02/02)
Editor's Note:
The SmartBrief news archive contains content appearing previously in SmartBrief publications. SmartBrief editors were not involved in the selection of these articles for the Sponsored Feature.
|
