By Jim Dwyer • May 11, 2020•Careers, Nonprofits and the Public Interest, Issues, Other Issues
Fraud in all forms and sizes may occur in healthcare, most especially now in the middle of a crisis. Health care fraud schemes are again on the rise. An unscrupulous medical doctor could, for example, use patient information to check for non-rendered services. There is also something called the unbundling of the medical code, whereby a patient is charged for every individual step of the procedure.
Enhance Biometrics Security
One way to combat medicare fraud and abuse is by applying biometric safety measures in hospitals. When a patient reaches a verification stage, the process is strengthened by biometrics — such as a fingerprint scanner, iris scanner, or facial recognition. Health facilities can use this type of security measure to match a person's file ID before access to private information is permitted.
Find Patterns with Modeling Predictive
Predictive modeling uses data extraction and quantitative analysis for fraud detection and the establishment of an action plan. The adjuster enters the information when a claim is filed, and the predictive model calculates a risk value, also called a suspicion score. As the score increases, medicare fraud and abuse is more likely to happen.
Valid data can reduce fraud and abuse in healthcare. Predictive modeling can detect fraud and behavior patterns in providers and seek out common indicators such as improper billing and kickback schemes. Health agencies can extract useful information from thousands of claims by means of data mining tools and identify a small group that needs further scrutiny. It is a more efficient and efficient approach to fraud detection than IT auditing.
Fraud Detection: 24 Hours
A broad range of industries uses AI to save money, time, and resources. It is also a flexible way of detecting and avoiding fraud in the healthcare industry. The program will adapt and learn to optimize the process by recognizing two key industry coding and billing errors that are most urgent. The patient's private and public insurance for the same service may be billed as an error. The additional fee could be more expensive than the billing code allows.
AI can work 24/7 without breaks or distractions. AI is consistent and error-free. Health facilities using AI can detect a number of department-wide errors and create more efficient and accurate claims processes.
To track data, use Blockchain
The majority of people have heard about Blockchain in cryptocurrency transactions as a transaction ledger. Many believe, however, that it could be a groundbreaking instrument to reduce health fraud. The most fraudulent practices in the healthcare industry begin with data handling or destruction. But it is not possible to remove or modify data with Blockchain.
Blockchain also provides detailed asset tracking, from where and where it came from. This transparency could be useful in the case of medicines from manufacturers to consumers by clinicians and other health care professionals trying. The simplicity and efficiency of tracking would enhance patient safety by finding significant problems from the beginning.
Cards with Microchips
The lack of safeguards to prevent over-filling, false records, and more is also a rampant reason for health fraud. The microchipped smart cards are one way to reduce these abuse. These cards are equipped with a microchip, which contains data that can verify the identity of patients. All information is encrypted to avoid falsification and falsification. While smart cards will not prevent any fraud, they can have a significant impact.
In fraud cases where the inspection during care is not required, cards are most practical. Smart cards can also be set up to store opioid prescription data, track medical history, and overdose. If a patient is suspected of being prescribed, clinicians will receive a warning in real-time.
The medical sector must find ways to adapt and improve new technologies as they develop rapidly. The detection and prevention of health fraud are one way to use technology. Predictive and artificial intelligence modeling can mine data and identify misgivings. Tec can also improve patients and care testing, such as biometrics and smart cards.