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Forum Session Announcement - Prevention and Early Detection of Health Care Fraud, Abuse, and Waste F O R U M S E S S I O NPrevention and Early Detection of Health Care Fraud, Abuse, and Waste A N N O U N C E M E N T A DISCUSSION FEATURING: Kimberly Brandt Director Program Integrity Group Centers for Medicare & Medicaid Services U. [...] health care system is "full of waste and abuse" and that his preferred health reform ap- proach would eliminate "hundreds of billions of dollars in waste and fraud."1 While the dollar amounts lost to fraud, abuse, and waste are not known for sure, the National Health Care Anti-Fraud As- sociation "estimates conservatively that 3% of all health care spend- ing-or $68 billion-is lost to health care. [...] The ex- tent to which significant program savings are achievable depends on the effectiveness of the tools used to detect fraud and abuse. [...] KEY QUESTIONS • What factors contribute to the prevalence of fraud, waste, and abuse in health care, and in Medicare in particular? Are there char- acteristics unique to Medicare's payment practices or beneficiaries that make the program vulnerable? • What is Medicare doing to prevent fraud and abuse and to mini- mize waste? How successful have these efforts been? • What are most effective anti-fr. [...] Arias will discuss common health care fraud schemes, the reasons he believes health care fraud is relatively easy to commit, and what actions Medicare and private insurers could take to better prevent and detect fraud.
The Ohio Department of Job and Family Services (ODJFS), as the Single State Medicaid Agency, has numerous processes to prevent and detect fraud, waste, and abuse in the Medicaid program. Various areas of ODJFS, the Ohio Attorney General's Office (AG), the Ohio Auditor of State (AOS), the United States Department of Justice, and the Department of Health and Human Services (HHS) each contribute to the oversight, detection and prevention of fraud, waste, and abuse for the ODJFS's, Office of Health Plans (OHP). ODJFS has dual overall purposes for program integrity of Medicaid: pre-payment education; and prevention of provider fraud waste, and abuse.
According to private and public estimates, approximately $24 million is lost per hour to healthcare waste, fraud, and abuse. A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud: Auditing and Detection Guide provides tips and techniques to help you spot—and prevent—the "red flags" of fraudulent activity within your organization. Eminently readable, it is your “go-to” resource, equipping you with the necessary skills to look for and deal with potential fraudulent situations.
Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.

SNI

National Criminal Justice Reference Service (U.S.)

Published: 1980

Total Pages: 770


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