The Real Impact of Healthcare Fraud

The Real Impact of Healthcare Fraud

The true cost of healthcare fraud should not be measured solely on the amount of money that criminals steal, but measured on the impact fraud has on entire system of delivering and innovating healthcare for individuals.

Globally, healthcare fraud accounts for an estimated $600 Billion annually. In the US alone, the estimate of healthcare fraud is between $68 billion to as much as $260 billion a year. But the “ripple effect” of healthcare fraud is huge.

It impacts providers of care such as doctors, medical practices, opticians, hospitals and clinics.  Not to mention pharmacies, pharmaceutical manufacturers, and almost every health insurance company.  In the end, healthcare fraud really impacts people who need healthcare and pay for healthcare – patients, their families, employers offering healthcare plans and the insurance companies that provide coverage.

Fraudulent practices are impacting every aspect of the healthcare system. For example, fictitious healthcare claims, claims based on identity theft, upcoding and overbilling for health services and unnecessary medicines for individuals.  These are all causing health insurance prices to rise. And yet, the dramatic increase and extensive range of healthcare crimes continue.

The range and cleverness of criminal schemes is quickly evolving.  Health insurance organizations are having a difficult time staying ahead of the fraudsters.   This results in higher premiums for insurance coverage, as well as higher fees for doctor visits, medicine and hospital stays. Throughout the chain of medical care, costs and reimbursements are out of control.

What’s Being Done and What You Can Do About Healthcare Fraud

The U.S government is in pursuit and has successful prosecutions of healthcare fraudsters and cybercriminals. But It is crucial that local, state and federal law enforcement keep up the pressure. Court verdicts encompassing significant prison terms and fines may be a deterrent to healthcare fraud. But the vast amounts of money involved are tempting potential new criminals more now than ever before.

So, it’s vitally important for corporations and organizations to take pro-active steps to monitor and manage the risk of healthcare fraud. The advanced healthcare fraud tools and techniques that criminal use today require advanced methods of detection and protection.  Tools that are more advanced than the fraudsters.

Business is moving rapidly, adopting new technology and doing their best to combat healthcare fraud.  And the single best way to stay ahead of the criminals is by using Artificial Intelligence. Executives in hospitals, healthcare systems and insurance companies are investing in AI and are optimistic that these investments will deliver ROI in short order and can help stop the scourge of healthcare fraud.

ToolCASE and the Use of Artificial Intelligence to Detect and Protect Against Fraud

The leader in providing Artificial Intelligence based healthcare fraud protection is ToolCASE.   Through its proprietary software, RembrandtAI, ToolCASE’s advanced Ai software systems power real- time monitoring and predictive analysis of transactions.

Informant, one of the key products provided by ToolCASE, is a full risk mitigation solution that monitors all transactions across all types and channels, in real-time.  And it does so with interactive capabilities.  Monitoring takes place on a dashboard that provides you alerts and visualization of transactions as they’re happening.  Not batched reports after-the-fact.

Accounting departments can use the RembrandtAI suite of software to save millions of dollars. Besides detecting and protecting your company against fraud, it can resolve customer inquiries, process authorized expenses, and assures regulatory compliance.

The RembrandtAI suite of software, exclusively available from ToolCASE, will protect your organization against healthcare fraud, and also help you manage your organization’s healthcare costs, overall.

Learn more about ToolCASE by visiting www.toolcase.com

The Real Impact of Healthcare Fraud
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