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:3/24/2017)... ... March 24, 2017 , ... Vighter established ... same time by providing Prehospital Trauma Life Support (PHTLS) course scholarships to four ... prehospital trauma education developed in cooperation with the American College of Surgeons to ...
(Date:3/24/2017)... ... ... According to a new study by NCPA Senior Fellow John R. Graham, "the ... has directed the CBO to follow. The CBO itself previously recognized Obamacare would kill ... a reduction in employer-based coverage due to the GOP reform, which is not plausible. ...
(Date:3/24/2017)... , ... March 24, 2017 , ... ... $100,000 for its innovative EcoQube Frame vertical micro-veggies garden on Kickstarter . ... for the product – with nearly 2,000 consumers (and counting) already backing the ...
(Date:3/24/2017)... , ... March 24, 2017 , ... Viewers who like ... of critical historical facts, cultural practices, goods, services, and societal issues tend to appreciate ... look into the popular practice of utilizing running events for causes around the world. ...
(Date:3/24/2017)... ... March 24, 2017 , ... “End Time GPS”: a ... will interrelate. “End Time GPS” is the creation of published author, Wesley Gerboth, ... working on military munitions and space-vehicle projects. Now, at age ninety-one, he shares the ...
Breaking Medicine News(10 mins):
(Date:3/23/2017)... , March 23, 2017 Mosaic Life Care, based in St. ... registration process across its network of 58 clinics, located in 22 cities, and its ... and innovative ways to improve the delivery of health care to its patients, including ... ... Mosaic Life Care St. Joseph Medical Center ...
(Date:3/23/2017)... , March 23, 2017  Transportation Insight, a multi-modal ... end-to-end supply chain management firm with expertise serving clients ... Solutions Rick Zaffarano was named a 2017 ... Supply Chain by the only publication exclusively dedicated to ... supply chain. "Rick has brought to Transportation ...
(Date:3/23/2017)... -- As a result of diagnostic technology increasing ... allergic diseases, cutting edge developments in targeted drugs ... in which pharmaceutical and biotech companies are addressing ... both a high quality meeting and a platform ... research scholars and doctors. The event will also ...
Breaking Medicine Technology: