"Result for Information"

While Medicaid focus on mere member eligibility, the MCOs reap the benefit

August 3, 2016

The attitude, the opportunity and the environment together bolsters certain individuals to abuse the healthcare system. When it comes to ineligible beneficiaries, fraud permeates in different dimensions from eligibility abuse and card sharing to Doctor shopping and drug diversion. However, not all the Medicaid abuse is directly attributable to ineligible beneficiaries, but, the payout of huge lot of such unnecessary premiums

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Fraud and abuse – the inconvenient truth

June 1, 2016

Things tend to go wrong if left alone. One of the most popular Murphy’s law states that Anything that can go wrong, will go wrong. To me it’s a loosely coupled adaptation of second law of thermodynamics; entropy – the measure of “disorder” always increases with time. We have always seen a glass falling down and shattered to pieces, but we never observe pieces of glasses come together to form a glass (shattered glass is […]

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Beyond the Obvious

January 5, 2016

In 2012 Donald Berwick, a former head of the Centres for Medicare and Medicaid Services (CMS), and Andrew Hackbarth of the RAND Corporation, estimated that fraud events (and the extra rules and inspections required to fight it) added as much as $98 billion, or roughly 10%, to annual Medicare and Medicaid spending – and up to $272 billion across the entire health system.

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