Preventing Different Kinds of Healthcare Fraud

We are seeing an increase in a new crime wave spreading throughout the country – healthcare fraud. All sorts of criminals and fraudsters are trying to exploit this and the vulnerability of the common man to fraud is becoming more widespread. We could prevent if we knew what to do. Here is a look at what this is and what we can do. We see Florida as the Healthcare fraud capital where seven deaths a day were reported in 2010 due to prescription pills. 

Susceptibility of health insurance providers

The number of preventing healthcare fraud has increased to four times in five years and everyone and everything in the healthcare system is susceptible to this. Both the government-run health insurance programs Medicare and Medicaid are slow to change and highly prone to exploitation. Medicaid has funds of $412 a year for settling claims and this is a big lure for the fraudsters. Medicare processes 4.5 million claims a day but only about 1.5% of this is audited. 

Upcoding and miscoding frauds

The most common type of fraud is indulging in miscoding. Here the users claim money for services they haven’t used. Examples include getting a nose job due to breathing difficulties when one hasn’t got it. Doctors use unapproved procedures on patients increasing the risk to them. Along with this, upcoding takes the top spot in terms of popularity. This means the medical service shows an expensive treatment while the patient receives only a less expensive one. Patients show more number of tests than what was actually done.

Another method fraudster’s use is unbundling. Knowing about this is the first step to medical fraud prevention. In this, patients provide bills for each item of a collective process that is provided as a bundle. This increases the cost to the insurer and the user makes money through the inflated costs. 

Take action to avoid fraud

You can do your bit to avoid being a victim of fraud. Ask questions and check for inconsistencies with your health history. Keep track of the tests and diagnosis you underwent and see that the records reflect this in the true sense. Keep a healthcare journal so that you always have a backup copy of the care you received. Use software from risk management providers like digital harbor to help detect fraud and risk.

They are the pioneers in this field and have brought out many innovative things such as Know Your Caregiver, Know Your Audit, and Know Your Provider technology among many others. You will be in control of your data so you will know the moment anything is out of place. Be sure to handle your Medicare, insurance, and social security cards with the same care you give to your credit cards.

Preventing the spread of crime makes it better for everyone especially white-collar crime that we cannot see. The efforts of organizations such as Digital Harbor have helped government units and private users operate under safer conditions. They provide AI-assisted software that helps detect risk and fraud before it happens so you can take action to avoid it.

Leave a Reply

Your email address will not be published. Required fields are marked *