Healthcare Fraud Shield’s Post

How can health plan SIUs sequence their investigations for greatest impact? This Cotiviti FWA webinar is now available on demand on our YouTube channel. Learn from industry experts about fraud, waste, and abuse best practices for achieving behavior change. You'll gain valuable insights with an end-to-end FWA approach. Watch and subscribe to our YouTube channel here. https://bit.ly/47687ky #FWA #HealthPlans

How can health plan SIUs sequence their investigations for greatest impact? This Cotiviti FWA webinar is now available on demand on our YouTube channel. Learn from industry experts about fraud, waste, and abuse best practices for achieving behavior change. You'll gain valuable insights with an end-to-end FWA approach. Watch and subscribe to our YouTube channel here. https://bit.ly/47687ky #FWA #HealthPlans

Recent studies show that Genetic Testing Fraud has increased significantly over the last 6-7 years. An increase in fraud reports show the importance of having your own personal protection. Context 4 Healthcare’s suite of FWA reports provides our users with several claims data analysis options for working to detect potential fraud situations such as those involving genetic testing. These include our FWA Provider Data Extract and our FWA Provider High Volume Report and Extract, both of which can assist our users in identifying potential unnecessary Genetic Testing situations. Do you protect yourself against similar trends? If not, connect with us today at: https://lnkd.in/gg7iDivd OIG Report on Genetic Testing Fraud: https://lnkd.in/d4xN8QQQ #healthcare #fwa #fraud #fraudprevention #genetictesting

There is an estimated $200B market opportunity that nobody seems to have a solution for. Market size is a leading factor in determining whether an idea is worth pursuing and digital health notoriously has much smaller market sizes than other life science investment opportunities. A good market size in MedTech and digital health must be north of $500M for your mainstream investors to be interested. If you have a market size that is north of $1B, then you have a much more interesting investment opportunity. Tens of billions market sizes doesn't really exist for medical device. But there is one market that is estimated to be around $200B, which is nearly double the entire digital health market, that doesn't seem to have anyone's interest that I can see, let alone a solution...and thats the market of healthcare fraud. I believe there are a few of reasons for this: 1. It is a very hard problem to solve. But at that size, isn't it worth working on? 2. The amount is actually very small, relative to the overall revenues in the category. 3. There is no exit opportunity, because 'success' is savings rather than revenues which theoretically would reduce the amount paid by everyone in the system...and may discredit premium increases. I don't think fraud is always the crooked doctor that just wants to make some extra cash. I think it is every single entity along the way that does not add value, but wants to take a piece of revenue whenever a patient happens to seek out care. And as a society, we allow this to happen! We sign up for paying tens of thousands of dollars every year just for the ability to pay a $25 copay. That 'luxury' we all pay for feeds the system, feeds the fraud and cycles back into higher and higher costs. The solution? Well I'm not arrogant enough to say I have the solution. But I believe that it starts with awareness, empowerment and in helping individuals find health solutions in a far more efficient manner. We figure that out, then I believe that would address much of the $200B fraud market naturally. #jpm2024 #healthcare #medtech #healthtech NHCAA INSTITUTE FOR HEALTH CARE FRAUD PREVENTION INC https://lnkd.in/gTgRti_J

In today's ever-evolving world, uncertainties are a certainty. Imagine your job is at risk or you're unable to work due to injury or illness. With our Income Protection, you're covered in the event of redundancy, company closures, or incapacitation. Get COVRD today. https://lnkd.in/dQdWgR2D #COVRD #IncomeProtection #PeaceOfMind

Here are 5 ways TPAs can prevent FWA in healthcare https://loom.ly/IOuJGto #FraudWasteAbuse #FWA #Naviquis #FraudInHealthcare #Prevent #PreventFWA

#AdvizeWize Tips from our Elite Investigators 💡 At Advize, we're committed to guiding you through the intricacies of investigation. We specialize in distinguishing between crucial and minor cases, exploring each lead with creativity and clarity. Partner with us to optimize your investigations for success. Are you an investigator? Share your insights in the comments! Let's keep our community informed. Stay tuned for more tips to maximize recovery and go beyond fraud detection with us! By Carey Mead - Lead Investigator at Advize Health LLC #AdvizeWize #TipsForInvestigators #SIU #MaximizeRecovery #AdvizeSolutions #OursourcedSIU #paymentintegrity #HealthcareSolutions #HealthcareInnovation #healthcarecompliance

#SIUInvestigators - How many of you have identified aberrancies beyond the initial allegation that led to a case being opened? Some of my biggest findings have been something other than the original concern. Be sure you are completing a thorough review of all claims data to maximize your recovery! #HealthcareFraud #SIU #ROI

Safeguarding your reputation, preserving your legacy. https://lnkd.in/d8xgm5AB #medmal101 #medmalinsurance #medicalmalpracticeinsurance #selectfirstinsurance #lowerpremiums #freequote #doctorsinsurance #medicalfacilities #healthcareprofessionals #professionalliability #groupcoverage #medicalgroups #sharedlimits #peaceofmind #legalconsequences #freequote #freeinsurancequote #freemedmalinsurancequote #claimsmade

As the healthcare industry continues to evolve, so do the challenges of fraud, waste, and abuse. This Cotiviti on-demand webinar provides a comprehensive overview of investigative strategies and trends to empower you to safeguard against potential risks and losses in 2024. For example, we're covering the latest CPT code changes and how to craft effective investigative work plans tailored to your organization's needs. Subscribe to our YouTube channel for more. https://bit.ly/3TcgM0x #FWA #coding #HealthPlans