"The best protection against health care fraud in the U.S. is a cautious and vigilant consumer, and all of us should be aware of common tactics and abuses that are driving up our health care costs," says Verizon Health IT Solutions Managing Director Renu Chipalkatti.
About 10 percent of the $2.6 trillion spent annually on health care goes to fraud and abuse, including falsified billings, false coding of services, billing for services not delivered or excessive, and billing separately for elements that should be part of a bundled service.
To help in the estimated $260 billion battle against annual health care fraud, Verizon offers six tips for consumers:
- Guard your personal information - Provide your insurance identification only to those who provide you with medical services and don't allow anyone to borrow your insurance identification/Medicare card.
- Beware of "free" medical services - If it sounds too good to be true, it probably is. A common fraud scheme has door-to-door or telephone sales people offering medical services or equipment for free in exchange for your insurance/Medicare identification number.
- Keep accurate medical records - Even if your doctor uses electronic medical records, you should always keep your own records. You could use a personal health information service or keep a written record of any medical services and medications you've received - just write down the doctor or doctors you saw, the services you received, and when they occurred.
- Review your medical bills - Be sure to ask for your bill at the time of your doctor visit. Then check your bills and compare it with your insurer's description of your benefits to make sure you aren't charged for services you didn't receive or charged for the same service twice. Also check that the dates of services and charges match up. If you find a problem or have questions, contact your health care provider immediately. If your questions are not resolved, contact your health plan provider.
- Destroy medical records before discarding - Be sure to shred or rip up any medical documents to stop your information from ending up in the wrong hands, or worse yet, having your identity stolen.
- Report possible fraud - If you suspect you're a victim of fraud, contact your health plan provider or the Department of Health and Human Services, Office of the Inspector General.
In an encouraging sign that efforts to combat health care fraud and abuse are gaining momentum, public and private health insurance companies are adopting new methods of detecting and preventing fraud. There are still some providers who use the "pay and chase" model - which is ineffective and expensive - but a growing number are focused on aggressive, proactive approaches.
Predictive modeling technology, for example, can proactively identify unusual patterns in provider behavior that can indicate fraudulent activity. Verizon offers this as part of a comprehensive set of prevention, detection and management tools to help combat fraudulent health care activity.
Verizon's Fraud Management for Healthcare service is able to monitor 100 percent of claims in near-real time and automates pre-payment detection with speed and efficiency. Verizon builds models to detect specific behaviors that signal fraud, flags them and assigns a priority based on a risk score so case managers can focus on the activities that will have the biggest impact.
Verizon's health IT practice offers a comprehensive portfolio of managed, IT and consulting services for the health care industry to help transform patient care delivery, enhance access to care and better manage costs.
Verizon Communications Inc. (NYSE, Nasdaq: VZ), headquartered in New York, is a global leader in delivering broadband and other wireless and wireline communications services to consumer, business, government and wholesale customers. Verizon Wireless operates America's most reliable wireless network, with nearly 96 million retail customers nationwide. Verizon also provides converged communications, information and entertainment services over America's most advanced fiber-optic network, and delivers integrated business solutions to customers in more than 150 countries, including all of the Fortune 500. A Dow 30 company with $111 billion in 2011 revenues, Verizon employs a diverse workforce of 184,500. For more information, visit www.verizon.com.