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Reducing Health Care Fraud, Waste & Abuse: How Much Is Enough?

Blog: Enterprise Decision Management Blog

Medical insurance claim form

Every day I see headline-worthy stories of convictions and legal settlements for fraud and abuse in health care around the world. Many health care payers’ SIUs or forensics teams spend their days “grinding it out” in the fight against health care fraud, waste and abuse — they may only aspire to these kinds of headline results.

So how does a health care payer measure success in payment integrity? How much is enough? Each payer tends to have their own point of view.

Here are four examples of “How much is enough?”

So how do you set your goals in the fight against losses to fraud, waste and abuse? How much is enough?

Whether your goal is to achieve structural change, or your goal is incremental improvement, we recommend that you do the following things.

In my next blog on health care fraud, waste and abuse, I’ll ask: “Who Do You Task with Responsibility for Payment Integrity?” I welcome your comments.

The post Reducing Health Care Fraud, Waste & Abuse: How Much Is Enough? appeared first on FICO.

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