A few weeks ago I discussed a few preventative measures a healthcare business can implement to protect itself from the damages of medical fraud.  However, the fight against medical fraud requires support from many groups, including the U.S. Government.  Bringing new tools to the fight, the Obama Administration recently announced aggressive new measures it is taking to reduce medical fraud. The Administration will be employing modeling tools to help predict potentially fraudulent or abusive activity before it occurs.

These new tools will be employed to fight abuses of Medicare, Medicaid and the federal Children’s Health Insurance Program, Obama Administration officials indicated.  The tools are designed to identify background information, for example, of potentially fraudulent individuals and links to questionable business affiliations.  The goal of this process is to prevent people from creating false healthcare providers or suppliers to act as a front for a scam.

Banks, credit card companies and insurance providers are also using many of these tools and strategies. The goal shared across all industries is to stop fraud before it occurs.  Preventing fraud is far less taxing on a business or organization in any industry than having to minize the potential financial damages caused after an incident.

It’s great that the Obama Administration is taking steps to help the healthcare industry fight medical fraud. There are many other tools out there that can support the fight.   The more industries can share fraud prevention tools with each other the stronger our collective ability will be to stop fraud before it happens.

Medical fraud is occurring at an alarming rate and is expected to cost the US healthcare system $100 billion a year.  Medical fraudsters vary in their sophistication and range from organized crime organizations to individuals preying on senior citizens.  For example, one crime syndicate stole the identities of doctors and thousands of patients to make false claims at bogus health clinics across 20 States worth $100 million.  Fraudsters working alone offer falsified free services as a tactic to acquire Medicare numbers to later bill insurers for supplies a patient never receives.

There are many things consumers can do to help prevent becoming a victim of medical fraud including not providing a Medicare number to a telephone solicitor of free services.  However, a recent article suggests that doctors, hospitals and insurers need to become more involved in protecting themselves from the damages caused by medical identity theft.

For example, medical providers should do more to verify and authenticate people who come to their offices for the first time.  A front office worker could ask the new patient to provide three forms of identification to ensure consistent names and addresses are used.  Secondly, office staff should verify the person actually lives at the address by running a credit check.   Lastly, if a potential fraud case is discovered, medical staff needs to be informed of how to contact the relevant authorities.

Protecting your business from medical fraud will not only reduce future headaches, but will protect your most valuable asset…loyal patients.