How Technology is Helping Combat Healthcare Fraud

Healthcare fraud is a significant issue in the U.S. and one that continues to grow in scale as fraudulent actors seek to exploit the healthcare system for their own financial gain.  According to the U.S. Department of Justice (D.O.J.), the cost of healthcare fraud in the country is close to $100 billion a year.

This figure encompasses a wide range of deceptive practices by healthcare providers, patients, and third parties which include billing for services not rendered, falsifying documents, offering or receiving kickbacks, and submitting false billing codes to secure higher reimbursements from government or private healthcare programs.

Recent advances in technology are now enabling government agencies to be more effective in their efforts to detect and prevent healthcare fraud. In this article, we will discuss some of the key technologies that can aid in combating the problem of healthcare fraud.

Data Analytics

Advanced data analytics are being used by the D.O.J. and other government agencies to help identify and prevent healthcare fraud. By analyzing vast amounts of data, suspicious activities such as abnormal billing patterns, overprescribing of drugs and other anomalies can be spotted highlighting potential fraud in the healthcare system.

AI and Machine Learning 

Artificial intelligence (AI) and machine learning (ML) can also play a significant role in detecting healthcare fraud. Predictive modeling using historical data sets can be used to identify patterns and anomalies which can help flag potential fraudulent activity. AI and ML can also be used in network analysis to analyze complex relationship links between healthcare providers, patients and other entities which could point to fraudulent schemes between parties.

Blockchain Technology

The immutability of blockchain technology makes it virtually impossible to alter or tamper with once a record or transaction has been made. As a result, the data integrity ensured through this technology makes it particularly effective in helping to combat medicare fraud in the context of identity theft. This practice entails stealing another person’s Medicare information in order to illegally obtain medical treatment or other healthcare services and fraudulently billing Medicare for those services using the victim’s identity.

Biometrics

Biometric verification can play a critical role in combating healthcare fraud. The use of biological characteristics such as facial or fingerprint recognition introduces a higher level of security for accessing healthcare data and information, mitigating the risks associated with traditional passwords which can be stolen or hacked. 

By authenticating the identity of healthcare providers and patients biometrics ensures only those authorized to access medical records or billing systems can do so, helping to reduce the possibility of fraudulent activities such as phantom billing or billing for services not rendered. 

Telemedicine

The remote delivery of healthcare services through technologies like video conferencing and remote monitoring devices can help to prevent healthcare fraud. Greater transparency is provided by recording all interactions and enabling the real-time verification of patients. This reduces the possibility of fraudulent activities such as identity theft, upcoding, and billing for non-existent services.

As technology continues to advance, it will bring many benefits to the healthcare sector, with significant contributions and advantages in the area of fraud prevention.