Targeting Healthcare Fraud by Data Mining

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1 Response

  1. Unreliable medical data aside, most fraud investigations are based on substanciated instances of fraud. The best way for service providers to avoid costly audit demands is to incorporate a compliance program into their organization's structure. With the standards of the Accountable Care Act and its fraud components becoming more mainstream for topics of conversation, many service providers still fail to put a program in place. The costs associated with having a compliance program in-house are far less significant than the fines we are seeing levied against service providers. I would hope that service providers would obtain a copy of HHS's  report regarding the implementation of the Fraud Prevetion System's claims-based methodogy and use it as a road map for instituting their own claims audit system.