HID’s Post

#Healthcare #fraud costs the US providers and payers $100 billion per year. How can we mitigate these costly frauds? By using #biometric technology to help prevent #IdentityTheft and #InsuranceFraud. Learn more: https://hid.link/J2n

🔍 Healthcare fraud can come in many forms. Learn what to watch out for and how to protect yourself from fraudulent practices. Get informed: https://lnkd.in/g_EUS-zD #Healthcare #FraudPrevention #LegalKnowledge #SBBLLaw #HealthcareLaw

Buttaci Leardi & Werner litigator Paul D. Werner weighs in on Part B News’ 2024 predictions regarding #telehealth fraud, remote patient monitoring, speaker programs, and COVID fraud. “We went from all the rules to effectively no rules, and now we’re back in a situation where the payers and Medicare are tired of hemorrhaging money on telehealth expenses. But patients and health care providers have gotten so accustomed to it that there’s this big pushback.” Paul further explains the significance of a recent OIG report regarding a fraudulent scheme involving remote patient monitoring – and why he believes providers should exercise even more caution in this new regulatory environment. To read the full article, please visit https://lnkd.in/gNBsHc3S. #ButtaciLaw #HealthcareLawyer #HealthcareLaw #Healthcare #FalseClaims #MedicalFraud #TeleMedicine #RemoteDoctor #Reimbursement

💬 Understanding healthcare fraud is essential for both providers and patients. Discover the key elements and how to safeguard against fraudulent activities. Read more: https://lnkd.in/g_EUS-zD #FraudAwareness #Healthcare #LegalHelp #SBBLLaw #FraudPrevention

There is an estimated $200B market opportunity that nobody seems to have a solution for. Market size is a leading factor in determining whether an idea is worth pursuing and digital health notoriously has much smaller market sizes than other life science investment opportunities. A good market size in MedTech and digital health must be north of $500M for your mainstream investors to be interested. If you have a market size that is north of $1B, then you have a much more interesting investment opportunity. Tens of billions market sizes doesn't really exist for medical device. But there is one market that is estimated to be around $200B, which is nearly double the entire digital health market, that doesn't seem to have anyone's interest that I can see, let alone a solution...and thats the market of healthcare fraud. I believe there are a few of reasons for this: 1. It is a very hard problem to solve. But at that size, isn't it worth working on? 2. The amount is actually very small, relative to the overall revenues in the category. 3. There is no exit opportunity, because 'success' is savings rather than revenues which theoretically would reduce the amount paid by everyone in the system...and may discredit premium increases. I don't think fraud is always the crooked doctor that just wants to make some extra cash. I think it is every single entity along the way that does not add value, but wants to take a piece of revenue whenever a patient happens to seek out care. And as a society, we allow this to happen! We sign up for paying tens of thousands of dollars every year just for the ability to pay a $25 copay. That 'luxury' we all pay for feeds the system, feeds the fraud and cycles back into higher and higher costs. The solution? Well I'm not arrogant enough to say I have the solution. But I believe that it starts with awareness, empowerment and in helping individuals find health solutions in a far more efficient manner. We figure that out, then I believe that would address much of the $200B fraud market naturally. #jpm2024 #healthcare #medtech #healthtech NHCAA INSTITUTE FOR HEALTH CARE FRAUD PREVENTION INC https://lnkd.in/gTgRti_J

Find and Fight Fraud Faster. 💪   FRAUD. Every health plan, TPA, and state Medicaid Director knows there is actual fraud happening in their system. The problem is that they either can’t see it or can’t see it fast enough to prevent payment and stop the bad actors before the damage is done. There is ONE primary reason for this problem, every healthcare claims editing system is claims data-centric in their approach to editing and analyzing claims.    To see complex fraud schemes, and to see them fast enough, you must be provider-centric in your claims editing and analysis approach. This enables healthcare payers to detect the provider behaviors and relationships that are indicative of actual fraud and collusion schemes.    As we gear up for the 2024 AAPAN Innovations Retreat, April 22-23 in St. Pete Beach, FL, 4L Data Intelligence looks forward to helping you and your organization Find and Fight Fraud Fast. #AAPAN American Association of Payers, Administrators and Networks #AAPAN2024 #providerintegrity #paymentintegrity #data #AI #healthcare #4LDATA #fraud

If you're in #healthcare, then you've likely heard about the #ChangeHealthcare data breach. Want to know the latest info? Listen up to find out! #DataBreach #RansomPaid #WhatsNext?

How much longer can we afford to ignore this? In 2022, per Centers for Medicare & Medicaid Services,  Medicare spending reached $944.3 billion. The U.S. Department of Health and Human Services (HHS) estimated a combined total of over $100 billion in improper payments in the Medicare and Medicaid programs in fiscal year 2023. This represents 43 percent of the government-wide total of estimated improper payments that agencies reported for that year. That's a whole lot of FRAUD! While fraud is intentional, all abuse is not. We know that AI can cause some harm, eh look at the lawsuit that  alleges UnitedHealth Group's algorithm-based technology prematurely cut off care to Medicare Advantage members. The technology was allegedly wrong 90% of the time. Al, could on the other hand, potentially help with fraud detection. Automated methods for detecting fraudulent healthcare providers have the potential to save billions of dollars in healthcare costs and improve the overall quality of patient care. CMS is adopting to the times. I will place a link in the comments of some of the ways that they are planning to leverage AI. What is your organization doing to protect itself? Also do you know where to report (link in comments) Comment Below and Follow Digital Risk Compliance Solutions for more info #healthcare #healthtech #femtech #aiinhealthcare #healthcareinnovation #fraud

The recent OIG report on Medicare’s use of remote patient monitoring (RPM) highlights critical gaps in oversight that could lead to inefficiencies, misuse, and potential fraud. The report noted that while RPM use has surged, about 43% of beneficiaries did not receive all the intended components of RPM services. Additionally, Medicare currently lacks important data, such as who is ordering these services and what specific health data are being monitored. This leaves the system vulnerable to improper billing practices and possible abuse. The OIG recommended several key actions to address these issues, including: Implementing safeguards to ensure RPM is being used and billed correctly. Requiring detailed claims to include the identity of the ordering provider. Identifying the type of health data being monitored. Educating providers on proper billing practices. Monitoring companies that bill for RPM to identify suspicious patterns. These steps aim to enhance the integrity and effectiveness of Medicare’s RPM services while preventing fraud and ensuring beneficiaries receive appropriate care. #connectedhealth #MedicareMonitoring #RemotePatientCare #HealthDataSecurity #PatientCareInnovation #HealthcareFraudPrevention #DigitalHealth #HealthcareCompliance #MedicareFraudPrevention #HealthcareBilling The full report can be found here: https://lnkd.in/gAbwsTBV

New Year, new opportunities to shed light on fraud! 🔎 As we usher in 2024, changes in laws and budgets can inadvertently create opportunities for healthcare fraud. Stay informed on these shifts in your workplace and learn to spot the signs of fraud to protect the integrity of our healthcare system. Knowledge is power! #WhistleblowerLawFirm #Whistleblower #HealthcareFraud