Healthcare Payer Strategies to Prevent & Detect Fraud


Health insurance fraud results in enormous losses every year – up to $260 billion, by some estimates. Preventing such losses and recouping the revenue is one of the most difficult challenges U.S. healthcare payers face, particularly once a fraudulent claim has been paid. And while technology advances have made it easier for payers to protect their bottom line – these advances are also aiding criminals.

According America’s Health Insurance Plans, small health plans that successfully deploy anti-fraud programs can save an estimated $5 million ($2.70 per enrollee), while medium-sized plans can save about $10 million ($1 per enrollee). Large health plans could retain $300 million ($3 per enrollee). Too bad the majority of healthcare payers are still trying to recoup money after they’ve paid the claim, according to the e National Health Care Anti-Fraud Association (NHCAA). This eBook will highlight the strategies that payers are using to detect and prevent fraud, including at the pre-payment stage in the claims cycle.

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By providing a deep-dive on a timely industry issue, Fierce eBooks are valuable educational tools. They are designed to be easily read online--but are also formatted so you can print them out and take them with you. Fierce eBooks are assembled like a mini-magazine: read the whole thing cover-to-cover, or pick and choose the articles that interest you most.