Tag: fraud detection

Ross Kaplan 0
The value of outside information

Most health care organizations either intentionally or due to some inability don’t use outside information (not just referals) in their search for fraud.  There are great numbers of valid reasons for this: HIPAA, security, usable/current data sources, inflexible information systems or processes, restrictive compliance & IT departments, and the list

Data for Good
Ross Kaplan 0
Health care fraud is on the rise

In the health care field, the impact of fraud, waste and abuse on payers -- whether insurance companies, government agencies or self-insured employers -- is enormous. Fraud losses weaken a payer’s financial position, with fraud loss estimates rivaling net income. Fraud losses feed the escalating care cost curve, undermining a