SOURCE: MarketResearch.com

MarketResearch.com

October 27, 2009 11:08 ET

Obama's Healthcare Reform Sheds New Light on Fraud Issues

ROCKVILLE, MD--(Marketwire - October 27, 2009) - MarketResearch.com has announced the addition of Datamonitor's new report, "Running in the Never-ending Race Against Healthcare Fraud (Strategic Focus)," to their collection of Healthcare market reports. For more information, visit http://www.marketresearch.com/redirect.asp?progid=67618&productid=2436373

Introduction

As healthcare reform takes center stage in the US, fraud is being recognized as a larger and more complex issue than most realized. In this report, Datamonitor surveys the current healthcare fraud market and examines both near- and long-term changes that will impact technology solutions and healthcare payers.



Scope

--  Provides an overview of market trends
--  Highlights priorities for solution development
--  Analyzes the pricing models of fraud solutions
    

Highlights

In healthcare fraud prevention, public sector leads the charge

Retrospective, prospective and real-time solutions should be used in tandem

Collaboration between public and private payers is key



Reasons to Purchase

--  Understand how the Obama administration is impacting healthcare fraud
--  Identify the near and mid-term threats to fraud detection
    

Topics covered in the report include…
Overview
Catalyst
Summary
    Key Messages
    In healthcare fraud prevention, public sector leads the charge
    Retrospective, prospective and real-time solutions should be used in
    tandem
    Collaboration between public and private payers is key
    Table of Contents
    Table of figures
    Market Opportunity
    Detecting healthcare fraud is a never-ending 'Red Queen's race'
    Both private and public payers are now shining a spotlight on
    healthcare fraud
    In an economic recession, payers are unable to pass higher costs onto
    patients
    Government led initiatives against fraud impact the private sector as
    well
    As providers move to EHRs and ICD-10, opportunities for fraud will
    likely increase
    Yet tackling healthcare fraud is still a sensitive subject that is not
    taken seriously
    Within a payer organization, fraud is a politically difficult topic to
    broach
    Payers do not want to alienate their provider networks
    While committing healthcare fraud may be a laughing matter, fighting
    fraud is not
    Technology Evolution
    Old and new tools are being used to fight fraud
    Healthcare fraud detection is slowly moving closer to real time
    Retrospective analysis of claims data will continue to play a role in
    catching fraud
    The use of prospective analysis is growing and the benefits are clear
    Regional health information organizations may increase collaboration
    between payers
    On-demand solutions are the easiest and most cost effective
    Educating doctors on good billing practices is a must
    Looking to the future, EHRs will change billing processes and, in turn,
    fraud detection
    Customer Impact: Recommendations to Healthcare Payers
    Be open to increased collaboration with other payers
    Incorporate patient inquiries as a part of the fraud detection process
    If financially possible, consider using more than one solution
    Go to Market: Recommendations to Technology Vendors
    IT vendors need to start focusing on medical identity solutions as well
    Vendors must take market education to a new level, the C-level
    It goes without saying, but technology companies should continue
    developing new tools
APPENDIX
    Abbreviations
    Methodology
    Further reading
    Ask the analyst
    Datamonitor consulting
    Disclaimer
List of Figures
    Figure 1: The number of stakeholders involved in the claims process
    makes it vulnerable to fraud
    Figure 2: Potential for fraud centers around the provider
    Figure 3: On the surface, claims processing seems to be straightforward
    Figure 4: A comparison of real-time, prospective and retrospective
    analysis
    Figure 5: Claim submission process will be streamlined in the future
    due to EHRs

For more information, visit http://www.marketresearch.com/redirect.asp?progid=67618&productid=2436373

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