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