Combating Overutilization of Healthcare Resources
Overutilization in Healthcare is a problem which has been estimated to cost in the range of hundreds of billions of US dollars every year. Despite historically spending more than double per person on healthcare than the average developed country, our outcomes have not been significantly better. To improve, specialty organizations publish clinical quality initiatives and practice guidelines that support consistent, focused, evidence-based care.
Keeping a watchful eye on telehealth claims
Telemedicine has grown significantly in recent years due to new technologies and consumer demand. According to an April 2017 study by Grand View Research, the telemedicine market is expected to grow to $113.1 billion by 2025 with an estimated compound annual growth rate (CAGR) of 18.8%. An anticipated 7 million patients in the U.S. will access telemedicine services in 2018, a sharp increase from 350,000 in 2013. Payer reimbursement policies, on the other hand, are slow to adapt to the new services.
When fraud causes patient harm, and how to find it before it does
It’s been called the most sinister, the most egregious, the worst kind of health care fraud – providers performing medically unnecessary procedures. When this type of fraud makes the headlines, it is indeed sensational.
OIG Work Plan FY-2017 - Monitoring Claims for Potential Fraud
The Office of Inspector General (OIG) Work Plan for Fiscal Year 2017 provides useful guidance for healthcare providers and payers to monitor their claims for potential fraud and quality of care concerns. The Work Plan (at https://oig.hhs.gov/reports-and-publications/workplan/) details areas where OIG will focus their review efforts by type of provider.
Combat Hospice Fraud with Careful Review of Claims
As long as there is profit incentive, fraud by wrongdoers can enter into the healthcare spectrum at any point. An increasingly common fraud scheme surrounds the care of the end-of-life patient in the hospice setting. In order for most payers to cover a patient receiving hospice care, a physician’s written certification that the hospice patient is terminally ill with a life expectancy of six months or less is typically required. Enter the fraud scheme – false certif ...