What can you learn in a minute? A LOT, if it’s a Madaket Minute.
In this latest #MadaketMinute, we’re diving into a healthcare fraud case that cost #Medicare, #Medicaid, and #PrivateInsurers over $13 million!
Wondering how payers can stay ahead of fraud like this? We’ve got the insights—fast. From the role of clean provider data to cutting-edge analytics that catch fraud before it spirals out of control, this Madaket Minute packs a punch.
You can’t afford to miss it. Stay tuned for a Madaket Minute that could save your organization millions!
Catch all the Episodes on our YouTube channel: https://www.youtube.com/@madakethealth
Read the video transcript below and subscribe to Madaket Health on YouTube.
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Video Transcript:
Last week, a federal jury found four licensed pharmacists guilty of engaging in a conspiracy to perpetrate health care fraud and wire fraud, incurring losses well over $13 million to Medicare, Medicaid, and Blue Cross Blue Shield of Michigan.
For payers, having accurate provider data plays a critical role in detecting and preventing fraud and overbilling. Accurate data analytics can alert payers to anomalies, like billing for services not usually tied with a provider’s specialty, or services provided at an improbable volume or frequency. Almost half of healthcare fraud comes from services that were billed and never performed, and performing services that weren’t medically necessary.
And to that point, last week a marketer of durable medical equipment pleaded guilty to participating in a multimillion-dollar health care fraud scheme that involved bribes and kickbacks to provide medically unnecessary durable medical equipment through telemedicine prescriptions, billing over $4.2 million.
Payers looking to figure out their risk for provider fraud, or to cut down on fraudulent billing should turn to innovative tech solutions first.
They need both clean provider data and a way to analyze their networks to identify opportunities to eliminate waste and fraud, especially the larger their network spans geographically.
Contact us at Madaket to learn how we can help you analyze your risk and revenue leakage.
