Archive | June, 2012

The Impact of Fraud on Taxpayers and the Government

22 Jun

The National Health Care Anti-Fraud Association estimates that up to 10% of the nation’s annual health care outlay may be lost to fraud and abuse and the government is by far the largest victim. The sheer size of the governments exposure to fraud within healthcare programs is of major concern because taxpayers foot the bill. The prevalence of consumer and provider fraud schemes requires ever more sophisticated tools to stem the tide ad lessen the impact of fraud on government and the taxpayer.

Consumer Fraud includes False Claims, medical identity theft and Physician shopping — where patients move between doctors to obtain multiple perscriptions.

Provider schemes often involve phantom billing and unbundling — charging separately for parts of a single procedure.

The sophisticated nature of even the most common fraud schemes requires continued vigilance and the development of tools that “dig below the surface” to monitor, detect, analyze and prevent fraud, waste and abuse.

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New Technologies Aid in Detecting Health Care Fraud

9 Jun

Ade Adebisi, CEO Ascellon Corporation

As Government agencies are increasingly turn to new technologies in the war against fraud, waste, and abuse, advances in data mining, fraud detection and program monitoring will play a major role.

New data mining technologies allow for fraud risk assessment based on comparing data, analyzing trends and comparing problem areas. Analysts can share and compare current and historical data across units and regions to identify current and prevent future fraudulent activity.

At Ascellon, we’ve found that providing analysts access to new technologies we’ve developed, increases the speed with which fraud is detected and ultimately increases ROI in detection technology.

Our product provides for advanced program monitoring and analysis, allowing team members to simultaneously examine specific datasets related to diagnosis, payment patterns, medical providers, patients, prescriptions, and demographic and peer-to-peer comparisons.

As agencies confront challenges facing government health care, they will find that the effectiveness of new tools that take advantage of the latest in data mining and fraud detection technologies, will have improved exponentially, while their costs have dropped significantly. Ascellon is committed to fighting fraud waste and abuse; providing new, efficient tools for detecting fraud and lifting the burden from taxpayers.