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.

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.

Answers in the Battle Against Health Care Fraud

30 Apr

By Ade Adebisi, CEO Ascellon Corporation

As the cost of health care fraud reaches $80 billion annually, Ascellon Corporation has developed “ANSWERS” as the first line of defense against fraud, waste and abuse in the health care industry.

According to the Federal Bureau of Investigation (FBI), health care fraud costs the United States $80 billion a year.  Rising cost estimates and the Bureau’s recovery of a record $4.1 billion in taxpayer dollars in 2011, illustrate the need for companies like Ascellon to become major players in identifying fraud, waste and abuse in health care systems.

The threat to federal and state government continues to rise, as organized crime syndicates, insurance companies, and individuals attempt to bill taxpayers for billions in payments to which they are not entitled.  To date, federal and state agencies have put in place recovery and audit contractors to help identify fraud in their health care systems.  But, government agencies and their contractors are having trouble developing efficiencies that move them past the “low hanging fruit” of managed care and fee for service in detecting systemic abuse.

Ascellon “ANSWERS” provides government agencies with ways to empower the analyst and identify fraud more efficiently than ever before. The software suite is built on the Microsoft BI Platform and combines traditional approaches to data mining with improved tools that allow analysts and investigators to quickly react to emerging trends in potential fraudulent behavior.  “ANSWERS” provides a cutting edge approach to post-payment claims analysis, data mining and medical record review system and helps agencies identify and safeguard against fraud, waste and abuse more quickly and efficiently.

Please join me and Microsoft’s Executive Director for Health and Human Services Policy, Bill O’Leary as we discuss “The Fraud Battlefield in Government,” one of many discussions on the challenges facing government health care organizations as well as the cutting edge technology being used to combat fraud, waste, and abuse around the country.