Healthcare Fraud Recovery $4.2B for 2012

Attorney General Eric Holder and HHS Secretary Kathleen Sebelius released a report today indicating that for every $1 spent on healthcare fraud and abuse recovery, $7.90 has been returned to the treasury over the past three years. With the Obama administration making recovery a top priority, this is the highest level of return in the 16-year history of the program.

Health Care Fraud Prevention and Enforcement Action Team (HEAT) was created in 2009 to reduce fraud, waste and abuse in the Medicare and Medicaid programs and to crack down on individuals and organizations that are bleeding the system. Last year, the Justice Department opened 1,131 new criminal fraud investigations involving as many as 2,148 defendants. Convictions have been achieved on 826 defendants in fraud-related crimes during the year. In the same year, the department opened 885 new civil investigations.

In 2012, CMS began screening all 1.5 million Medicare-enrolled providers through the new Automated Provider Screening system. APS fingers ineligible and potentially fraudulent providers and suppliers prior to enrollment or revalidation. Nearly 150,000 ineligible providers have been eliminated from Medicare’s billing system so far. 

CarePrecise's standard database of healthcare providers includes a field that indicates providers who may still be active, but have been added to the federal List of Excluded Individuals and Entities, tying excluded providers to their NPI numbers.

Exchange and Medicaid IT Contract Tracker

State Refor(u)m has created a chart that tracks states' choices of firms to build health insurance exchanges and Medicaid systems, with details on technical roles performed by vendors and on some of the software components vendors will use. The chart was produced by the Office of Health Policy and Technology at the University of Massachusetts Medical School. States can help State Refor(u)m keep the tool updated by using the page's comments section to post information about similar contracts awarded in their states.

CarePrecise provides healthcare provider information to state insurance exchanges, health information exchanges, Sunshine Act programs, healthcare fraud investigations and other state and federal healthcare projects.

Visit the Exchange and Medicaid Systems Contracts Chart to see who's doing what on whose project, and to add your own.

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CarePrecise is a sponsor of Big Data for Healthcare Forum, April 29 - May 1, 2013. Join us there!

15 Types of Medical Billing Fraud & Abuse

Estimates of U.S. medical fraud and abuse go as high as $80 billion. It contributes significantly to rising healthcare and insurance costs.  The complexity and fragmentation of the American healthcare billing landscape is frequently a culprit makes fraud and abuse easier to commit and more difficult to detect.

One of our long-time clients, PayerFusion, has just published an article on its blog highlighting fifteen different forms of fraud and abuse, including upcoding, cloning, phantom billing, and a dozen more. Read the article for useful and timely information on this important subject.

CarePrecise provides software, data and services employed by law enforcement, including the Federal Bureau of Investigation, in ongoing investigations. To report fraud or abuse, go to http://oig.hhs.gov/fraud/hotline/
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CarePrecise encourages you to attend the Big Data for Healthcare Forum, April 29 - May 1, 2013.

Data Security: An Online Hacking Primer

Medical records security has been rising to the top of mind among the healthcare IT community. As HIPAA now has some teeth and has been extended to contractors, it is wise to remember that three in four Americans have fallen or will fall victim to cyber crime as a result of having been hacked. Among the systems that have infamously leaked personal information are those of universities and hospitals. The following infographic offers an overview of the personal information leakage going on out there. Thanks, Allison!

Infographic courtesy OnlineCollegeCourses.com.

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CarePrecise encourages you to attend the Big Data for Healthcare Forum, April 29 - May 1, 2013.