Navigation Links
HDM Offers Solution to Health Care Fraud Cited by CNN and Health Plan Week
Date:8/11/2009

KING OF PRUSSIA, Pa., Aug. 11 /PRNewswire/ -- A recent report on CNN pointed out that only 40 pages of the more than 1,000-page House Healthcare Reform Bill addresses fraud, which by various estimates is a $75 billion to $300 billion a year problem.

An article published in a recent issue of Health Plan Week reported that the Blue Cross and Blue Shield Association's national anti-fraud department claimed that anti-fraud investigations in 2008 turned up $350 million in savings, a 43 percent increase from the previous year.

In commenting on the CNN and Health Plan Week stories, David McSweeney, COO of Healthcare Data Management, Inc. (HDM), a leader in audits and analytics for self insured health plans, said, "I'm glad to see health insurance fraud getting the attention it deserves. We've been battling fraud and honest mistakes since 1992. There isn't an approach to fraud that we haven't seen, and there's one irrefutable fact we've learned -- retrospective audits can be ineffective in spotting health insurance fraud before it becomes a big problem."

The Health Plan Week article claimed these principal types of fraud: 1) providers who are doing things like upgrading to gain higher reimbursements for services, 2) billing for services not rendered, 3) "phantom" providers or identity theft and 4) prescription drug scams.

The same article reported that a recent white paper by the National Health Care Anti-Fraud Association (NHCAA) estimated that as much as 10% of U.S. healthcare costs -- ($224 billion) in 2007 alone -- was fraud. The NHCAA is proposing that reform legislation include more information sharing between government and private health insurers to help solve this problem.

"I'm sure that information sharing would help," McSweeney said. "However, we believe there's no substitute for catching the scammers -- whether they be providers or plan members or friends of members -- than for plan sponsors to institute an ongoing system of surveillance by an independent third party.

HDM has launched a service called BenefitsWatch, which enables a self-insured company to provide its clients with quarterly reports based on monthly data feeds of paid claims from insurers. "BenefitsWatch catches fraudulent actions before they become big, often unrecoverable problems," McSweeney explained. "It can actually link Rx and Medical claims to track prescriptions back to the appropriate diagnosis, if there is one."

With BenefitsWatch, HDM analyzes 100 percent of supplied claims in a client customized data warehouse, against "exceptions" or deviations from plan documents. BenefitsWatch also applies HDM's own proprietary benchmarks to analyze three critical areas of plan performance... compliance, budget and cost and utilization.

For more information about HDM and BenefitsWatch, visit www.hdminc.com.


'/>"/>
SOURCE Healthcare Data Management, Inc.
Copyright©2009 PR Newswire.
All rights reserved

Related medicine news :

1. Health care incentive model offers collaborative approach
2. Eye-staining technique offers early detection for dry eye syndrome
3. Governor Rendell Offers adultBasic Coverage to 35,000 Uninsured Pennsylvanians
4. Mylan Commences Tender Offers and Consent Solicitations for Its 5.750% Senior Notes Due 2010 and 6.375% Senior Notes Due 2015 in Connection With Its Proposed Acquisition of Mercks Generic Pharmaceutical Business
5. Psoriasis Cure Now offers Back to School Resources for Parents of Children with Psoriasis
6. ADDAS Awareness Campaign Offers Resources and Education to Adults Living with AD/HD and Professionals Working With Them
7. Regence Offers InterM to Fill Gap for the Uninsured
8. National Non-Profit Organization Offers Free Mental Health Services to Military and Military Families
9. Blue Cross Blue Shield of Michigan Offers New Approach to Customer Group Wellness
10. ProAssurance Group Offers Coverage for Community Based Hospitals in Michigan
11. Super Jake Foundation Offers Hope for Pediatric Cancer
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:7/26/2017)... , ... July 26, 2017 , ... Wendy M. Musielak, a partner at ... elected as DuPage County Bar Association’s third Vice President earlier this year. She will serve ... office of the second Vice President, in accordance with the organization’s by-laws. , Musielak ...
(Date:7/26/2017)... ... July 26, 2017 , ... The number of adults 65 years or ... ways to improve asthma control in the population are not well described. In a ... Practice), an official journal of the American Academy of Allergy, Asthma & Immunology (AAAAI), ...
(Date:7/25/2017)... (PRWEB) , ... July 25, 2017 , ... Summers in ... up the air conditioner — think homemade gourmet ice cream, sparkling pools, and mile-high ... gift shop featuring fun mugs, journals, and other must-have knick knacks. Ice cream and ...
(Date:7/25/2017)... ... July 25, 2017 , ... ... launch of their partnership to provide the Pharmacist eCare Plan to ... in the country with the ability to develop the Pharmacist eCare Plan, a ...
(Date:7/25/2017)... D.C. (PRWEB) , ... July 25, 2017 , ... ... and their clients, today announced it will be exhibiting and providing demos of ... at the Walter E. Washington Convention Center in Washington D.C. from August 3-6, ...
Breaking Medicine News(10 mins):
(Date:7/21/2017)... and EDMONTON, Alberta , July ... and the University of Alberta in ... in Nature,s partner journal, Schizophrenia 1 , demonstrating ... instances of schizophrenia with 74% accuracy. This retrospective ... of specific symptoms in schizophrenia patients with significant ...
(Date:7/19/2017)... N.C. , July 19, 2017  Mako Medical ... Affairs, and the Military Family Assistance Fund (MFA) to ... to visit with their families one last ... funding to coordinate the travel and logistics needed for ... our deployed soldiers and their families. We just wish ...
(Date:7/13/2017)...  Centurion Medical Products, a leader in medical product innovation and ... removal device for hospice patient care. ... Centurion Medical Products ... Patient pain management and emotional comfort are part of a ... pain while preventing unneeded emergency department admission due to severe fecal ...
Breaking Medicine Technology: