As if health care wasn't scary enough. LexisNexis Risk Solutions released a list of top trends in health care fraud, waste and abuse. They are:
The rise of organized crime in health care fraud. In recent years, criminals have migrated from illegal drug trafficking to perpetrating fraud schemes against Medicare, Medicaid and private health insurance companies.
Increased fraud vulnerabilities due to migration to EHRs and ICD-10. Concerns surrounding medical identity theft and data privacy are increasing as personal health information goes electronic.
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Crackdown on improper payments, led by the Centers for Medicare & Medicaid Services. In addition to recovering improper payments and reducing payment errors, new provider enrollment rules under the PPACA seek to ensure that providers and suppliers are screened for their risk of committing fraud, waste and abuse before being allowed to enroll in federal programs.
The need for better patient information. With general statistics showing that five to 10 percent of individual contact information provided by commercial carriers is incorrect and 25 to 30 percent of individual contact information provided by Medicare is incorrect, it's no wonder payers are challenged with HEDIS reporting and providers' revenue cycles.
Increased medical identity theft. Consumers' increased use of online and mobile tools—along with personal health records—can open doors to theft and create even greater risk to misuse of information. Medical identity theft and health care fraud are a significant burden on the United States health care system with industry reports showing the annual cost of fraud in the U.S. estimated to be between $60 and $200 billion.
"Unfortunately, it's a reality that fraud is one of the drivers of the rising costs of health care in both the private and public sectors," says Harry Jordan, vice president of health care for LexisNexis. "Proactively preventing fraud benefits everyone—patients, providers, and payers. It enables the health care community to focus on delivering high quality care, and helps mitigate the increasing costs of that care."
LexisNexis is hosting its 2012 Annual HIMSS Conference & Exhibition Feb. 20-24 in Las Vegas, Nevada, that will discuss how to leverage technology to address these health care problems.
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