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PCMA: Anti-Fraud Report Highlights Concerns About ACA Implementation

HealthLeaders Media Staff, October 22, 2010

The NHCAA offers seven principles to guide regulators and policymakers as healthcare reform is implemented:

  1. The sharing of anti-fraud information between private insurers and government programs should be encouraged and enhanced.
  2. Data consolidation and real time data analysis must be at the forefront of healthcare fraud detection and prevention.
  3. Pre-payment reviews and audits should be increased and strengthened.
  4. Public and private health plans should be allowed to protect their enrollees by barring or expelling providers suspected of perpetrating healthcare fraud.
  5. Healthcare providers participating in fraud should be sanctioned by their respective state licensing boards.
  6. Healthcare provider identifier numbers should be made more secure.
  7. Investment in innovative healthcare fraud prevention, detection, and investigation efforts and programs should be encouraged.

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