Navigation Links
New Analysis Examines Fraud in Both Private and Public Health Insurance Markets
Date:6/26/2009

WASHINGTON, June 26 /PRNewswire/ -- A new report from The George Washington University School of Public Health and Health Services, Department of Health Policy challenges the notion that fraud is a problem only in public health insurance markets and finds that fraud is a system-wide problem affecting private and public health insurance alike. The report finds that some of the most striking examples of fraud come from fraud committed directly by the private insurance industry itself. In 2007, when the U.S. spent nearly $2.3 trillion on health care and public and private insurers processed more than 4 billion health insurance claims, fraud was estimated to reach as much as 10 percent of annual health care spending. At this rate, the losses in 2007 alone -over $220 billion - would have been enough to cover the uninsured. The National Health Care Anti-Fraud Association (NHCAA) has estimated conservatively that 3 percent of all health care spending--or $68 billion--is lost to health care fraud.

The report finds that no segment of the health care industry or geographical area is immune from fraud. It is estimated that 80 percent of healthcare fraud is committed by medical providers, 10 percent by consumers, and the balance by others, such as insurers themselves and their employees. Fraudulent billing, kickbacks, up-coding services and bundling are common examples of fraud. Avoidance of sick and high need members, along with the systematic misrepresentation of the cost of care to group plan sponsors, represent major examples of fraud in the private insurance industry.

The report also notes the distinction between fraud and improper payments. Fraud is a misrepresentation of the truth or concealment of material facts. Improper payments, on the other hand, tend to involve technical questions associated with verification of claims or related matters. The report also describes recent efforts to improve fraud detection and recovery across the public and private insurers, including Medicare and Medicaid.

"The evidence presented in this analysis should put to rest the notion that the problem of fraud is limited to public programs. Because fraud can arise in any sector of the health industry, comprehensive efforts to both detect and deter fraud system-wide are essential to national health reform," said Sara Rosenbaum, Professor and Chair, Department of Health Policy.

"Health Insurance Fraud: An Overview" is available at http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_EFDAD1BC-5056-9D20-3D3D36632A4F2163.pdf%20ht

About The George Washington University Medical Center

The George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high-quality medical care in the Washington, DC metropolitan area, since 1824. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation's capital; GW Hospital, jointly owned and operated by a partnership between The George Washington University and a subsidiary of Universal Health Services, Inc.; and the GW Medical Faculty Associates, an independent faculty practice plan. For more information on GWUMC, visit www.gwumc.edu.

All news releases available online www.gwumc.edu/mccm

This news release was issued on behalf of Newswise(TM). For more information, visit http://www.newswise.com.


'/>"/>
SOURCE George Washington University
Copyright©2009 PR Newswire.
All rights reserved

Related medicine news :

1. Study, meta-analysis examine factors associated with death from heatstroke
2. Latest DES Analysis Stresses Importance of Physicians Well-Trained in Implantation Technique and Patient Follow-Up
3. Consumer Reports Analysis: Drugs for Nerve Pain, Fibromyalgia Effective, But Not Always Best
4. Takeda statement on ACTOS meta-analysis published in the Journal of the American Medical Association
5. Takeda Statement on ACTOS(R) (Pioglitazone HCl) Meta-Analysis Published in the Journal of the American Medical Association
6. Physical Therapist Provides Injury Analysis for Fantasy Football
7. Sanofi-Aventis renews licenses for Genomatix chip analysis pipeline
8. Meta-Analysis of Blood Phe Levels and Clinical Outcomes in PKU Published
9. OCS and Press Ganey Partner to Create Joint Analysis of Outcomes and Satisfaction
10. New Analysis Underscores Legality of Physician Ranking and Public Reporting Systems When Used by Health Insurers to Improve Health Care Quality
11. Barta joins Conseco as Senior Vice President, Financial Planning & Analysis; Barra named Senior Vice President, Internal Audit; Clarke to head Investor Relations
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:4/30/2016)... , ... April 30, 2016 , ... Orlando-based Maximized Living ... they go for gold in Rio. Under the care of Maximized Living doctors ... , In an unprecedented showing, Maximized Living is sending the largest contingent of elite ...
(Date:4/29/2016)... ... April 29, 2016 , ... Since launching its annual volunteer ... serving the footwear industry, has broken all previous participation records in its first ... 23 states during the months of April and May, the 2016 Footwear Cares ...
(Date:4/29/2016)... (PRWEB) , ... April 29, 2016 , ... On Tuesday, ... hospitals across the Southeast, celebrated the signature of Gov. Nathan Deal on SB 258, ... Geoff Duncan (R - Cumming), offers a 70% tax credit to individuals and corporations ...
(Date:4/29/2016)... ... April 29, 2016 , ... Conditions were ideal for Global Lyme Alliance’s (GLA) ... with sunny skies, a light breeze and temperatures in the 60s. Over 400 runners, ... Run and Walk and 1-mile walk were held to increase awareness about Lyme ...
(Date:4/29/2016)... , ... April 29, 2016 , ... ... that student team BioCellection won the $30,000 Perlman Grand Prize of the 2016 ... Gloeckner Undergraduate Award, the Michelson People’s Choice Award, and the Committee Award for ...
Breaking Medicine News(10 mins):
(Date:4/28/2016)...   Acsis , a leading provider of supply ... research and advisory firm IDC has named it a ... Pharmaceutical Track and Trace Software 2016 Vendor Assessment (doc ... of the capabilities and business strategies of 10 vendors ... Logo - http://photos.prnewswire.com/prnh/20160427/360791LOGO ...
(Date:4/27/2016)... 27, 2016  Hologic, Inc. (Nasdaq: ... for the fiscal second quarter ended March 26, ... $0.24 increased 41.2%, and non-GAAP diluted EPS of ... 5.8% on a reported basis, and 6.3% on ... posted another good quarter, highlighted by 14.6% growth ...
(Date:4/27/2016)... Italy , April 27, 2016 ... linear accelerator (MR-linac) platform will be the focal point ... meeting of the European Society for Radiotherapy & Oncology, ... Elekta,s MR-linac integrates a state-of-the-art radiotherapy system and a ... physician to clearly see the patient,s anatomy in real ...
Breaking Medicine Technology: