Stopping healthcare fraud with tools used in other industries

February 1, 2011 by bkrenek

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.