The $80+ Billion Price Tag of Healthcare Fraud

Each year, healthcare fraud and abuse drains off tens of billions of dollars that might have gone to lower medical insurance premiums and expanded prevention and treatment services for patients. Although countering these schemes can be difficult, data mining and other interventions may help to defray at least some of the damage, experts noted during a recent webinar.

One reason why anti-fraud measures can be a huge challenge is the fast-paced nature of pharmacy claims processing, said Carrie Aiken, CHC, the vice president and corporate compliance and privacy officer at Navitus Health Solutions, a Pharmacy Benefit Manager (PBM) owned jointly by SSM Health and Costco Wholesale Corp., and the sponsor of the webinar. “Pharmacy services are processed in real time,” Ms. Aiken explained. “That makes fraud, waste and abuse in the pharmacy space a crime of opportunity because it’s rapid. As a result, it requires rapid intervention to make sure we’re protecting those dollars for our plan sponsors and protecting beneficiaries.”

Read more by clicking the link to the full article below.

MORE ABOUT Carrie Aiken

As Chief Administrative Officer, Carrie provides active leadership and support for the organization’s Human Resources, Corporate Compliance, Information Governance, and Fraud Programs.
In this role, Carrie is accountable for day-to-day implementation, performance and maintenance of company processes and controls.
Carrie has more than 25 years of experience across several health care disciplines, including physician, hospital, home health, and pharmacy, as well as contracting and revenue cycle. She has been involved with HIPAA since the inception of the privacy and security rules.