While fraud is technically different from waste and abuse, data shows that technological solutions fail to fully tackle any of these issues. The losses are in the billions, and the only way to solve it is through system visibility and proactive methodology.

How to Fix It

In order to fully eliminate the overpayment crisis, it’s imperative that health organizations take a complete look into the issues that have not yet been tackled. With losses totaling $36 Billion plus per year, this is an issue that must be resolved ASAP. A solid solution must be able to quickly identify where the leakage is coming from at your organization. A combination of the following knowledge can help you combat fraud, waste and abuse:

Efficiency

Wasteful spending can easily amount to one-third to one-half of healthcare spending. Administrative complexities are partially responsible for the issue, so it makes sense that increased efficiency can dramatically impact overall wastefulness. If you’re not focused on achieving efficiency, you will always struggle with containing wastefulness.

Waste and Abuse Outweigh Fraud

Fraud is when someone is purposely playing the system in order to benefit from it. However, fraud is quite rare and only makes up about 7% of spending when combined with healthcare abuse. For obvious reasons, the fear of fraud can be significant, which can lead to overinvesting in technology that does not completely encapsulate all of the overspending issues–especially waste.

Partnerships Help

Patient-payer partnerships open the door for further improvements in safety, communication, and the reduction of unnecessary costs. Collaboration allows for investment from all parties involved in preventing fraud, waste and abuse.

Shared Reporting Should Be Ongoing

Healthcare organizations should take regular looks at their metrics, while also sharing their findings with all related parties–including providers, staff and vendors. Openly shared information is beneficial to everyone seeking to reform fraud, waste and abuse within healthcare organizations.

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