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What You Don’t Know about Fraud, Waste and Abuse Part 2

In order to completely remedy the overpayment issues – meaning fraud, waste and abuse (FWA) – organizations must illuminate the areas of this issue that have not been tackled yet. In 2016, it was estimated that the Medicaid improper payment…

WhitehatAIJuly 18, 2019

Fraud Waste & Abuse

What You Don’t Know about Fraud, Waste and Abuse Part 1

Fraud is a different issue than waste and abuse, but most technology fails to address any of these issues. If you think you know how to manage fraud, waste and abuse (FWA) at your healthcare organization, you should probably be…

WhitehatAIApril 25, 2019

Fraud Healthcare Claims Waste & Abuse

Managing Telehealth Claims

Telemedicine has significantly grown over recent years, primarily due to evolving technology and consumer demand. It’s anticipated that by 2025, the telemedicine market will have grown to $113.1 billion. In 2018, around 7 million patients in the U.S. accessed telemedicine…

WhitehatAIApril 5, 2019

Fraud

How to Combat the Overutilization of Healthcare Resources

Overutilization of healthcare resources is a major issues that costs hundreds of billions of dollars each year. To help circumvent this, the American Board of Internal Medicine (ABIM), has recommended a reduction in the use of tests and procedures that…

WhitehatAIMarch 28, 2019

Fraud Healthcare Fraud Waste & Abuse

Spotting the Patterns in Healthcare Fraud and Abuse

Prior to the ability to electronically process claim submissions, the only choice payers had for fraud, waste and abuse detection were manual auditing processes. This is very timely and costly to a company, and is susceptible to human error. Even…

WhitehatAIMarch 4, 2019

Fraud Insurance Insurance Fraud

Insurance Fraud and Patient Harm

In recent years, it’s become more and common to see headlines touting health care providers performing medically unnecessary procedures in order to collect more insurance money. Not only is this sensational, it’s horrific and it’s important that we do what…

WhitehatAIFebruary 23, 2019

Artificial Intelligence Fraud Machine Learning Waste & Abuse

Pre-Payment Prevention Lowers Healthcare Losses

While there are a variety of tools and solutions available to combat fraud, abuse, and waste, lately pre-payment prevention has come to the forefront. Today we’re going to explore why. Consider This Payment policies and your claims adjudication systems are…

WhitehatAIFebruary 5, 2019

Artificial Intelligence Fraud Healthcare Fraud Machine Learning

AI and ML Abilities to Catch Fraud

Data analytics algorithms have the ability to identify unique patterns within your claims, such as claims that are being repeatedly declined but are then never re-billed correctly. This is a red-flag that a fraudster is fishing to see if your…

WhitehatAIJanuary 28, 2019

Artificial Intelligence Fraud Healthcare Fraud Machine Learning

AI and ML Adaptive Learning Helps Fight Fraud

Machine learning (ML) algorithms inherently practice adaptive learning. If this sounds intimidating, you can look at it like an email filter. You initiate the identification of spam emails, then, over time, your email is able to identify spam without your…

WhitehatAIJanuary 4, 2019

Artificial Intelligence Fraud Machine Learning

Using Artificial Intelligence and Machine Learning to Fight Fraud

It’s simple for data analysts and fraud investigators to know what red flags they’re seeking out in the data they look at and what questions they need to be asking. It could be “was a payout made for a deceased…

WhitehatAIDecember 28, 2018