[{"innerBlocks":[],"name":"core\/freeform","postId":3434,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"Healthcare has entered the era of \u201cCompliance 2.0,\u201d fueled by information technology and analytics designed to root out fraud, contends Daniel Levinson, Inspector General of the Department of Health and Human Services.

Levinson, who has headed the HHS OIG for more than a decade, made the remarks in a keynote address at last week\u2019s Health Care Compliance Association conference.

\u201cWe\u2019re really looking at a different era,\u201d which is bringing \u201ctogether technology with the right expertise,\u201d said Levinson during the 2017 HCCA Compliance Institute. \u201cWhen we got off the ground in the mid-1990s, it was really the beginning of the Internet age. A lot has happened in 20 years technologically. Now, we have the kinds of tools that we couldn\u2019t have imagined 20 years ago.\u201d

For its part, OIG\u2019s mission is to protect the integrity of HHS programs and operations, by detecting and preventing fraud, waste and abuse. According to Levinson, IT is playing an enabling role bolstering fraud detection and prevention.

\u201cOn the healthcare fraud side, we\u2019re working very productively with the Healthcare Fraud Prevention Partnership, with private payers and us at the table,\u201d added Levinson.

Created in 2012, HFPP is a voluntary public-private partnership advancing the detection and prevention of healthcare fraud, waste and abuse by sharing data industry-wide and collaborating on effective methodologies. HFPP is the only organization through which partners can combine their data with that from the Centers for Medicare and Medicaid Services to gain anti-fraud insights using enhanced analytics.

Also See<\/b>: 3 ways to curb fraud with advanced analytics<\/a>

\u201cWe\u2019re really able to share important information about risk areas and about the kinds of things we see both on the private and the public side. So, we\u2019re able to catch various schemes much earlier than we had been able to in years past,\u201d added Levinson.

He noted that home health services is a growing area of healthcare that requires more attention and focus for fraud detection. Levinson referenced the recent Texas case of Jacques Roy, MD, who orchestrated a massive Medicare fraud scheme by submitting $375 million worth of bills for bogus home health services.

\u201cHome health is now such a large part of what we see\u2014we spend probably $18 billion to $19 billion at HHS on home health agencies for 11,000 different providers,\u201d Levinson concluded. \u201cThere are serious vulnerabilities when it comes to home health because it is more difficult to track.\u201d

At the same time, he said Medicaid program integrity \u201cremains a very significant challenge because as we move more towards managed care\u2014from the standpoint of us as auditors and evaluators\u2014we see a system that is much more opaque than really suits our ability to assure that taxpayer dollars are being used appropriately.\u201d Regulators want to know who HHS is \u201cdoing business with\u201d and \u201cproviders are qualified,\u201d and the \u201cmoney is going to people who deserve those fees.\u201d","saveContent":"Healthcare has entered the era of \u201cCompliance 2.0,\u201d fueled by information technology and analytics designed to root out fraud, contends Daniel Levinson, Inspector General of the Department of Health and Human Services.

Levinson, who has headed the HHS OIG for more than a decade, made the remarks in a keynote address at last week\u2019s Health Care Compliance Association conference.

\u201cWe\u2019re really looking at a different era,\u201d which is bringing \u201ctogether technology with the right expertise,\u201d said Levinson during the 2017 HCCA Compliance Institute. \u201cWhen we got off the ground in the mid-1990s, it was really the beginning of the Internet age. A lot has happened in 20 years technologically. Now, we have the kinds of tools that we couldn\u2019t have imagined 20 years ago.\u201d

For its part, OIG\u2019s mission is to protect the integrity of HHS programs and operations, by detecting and preventing fraud, waste and abuse. According to Levinson, IT is playing an enabling role bolstering fraud detection and prevention.

\u201cOn the healthcare fraud side, we\u2019re working very productively with the Healthcare Fraud Prevention Partnership, with private payers and us at the table,\u201d added Levinson.

Created in 2012, HFPP is a voluntary public-private partnership advancing the detection and prevention of healthcare fraud, waste and abuse by sharing data industry-wide and collaborating on effective methodologies. HFPP is the only organization through which partners can combine their data with that from the Centers for Medicare and Medicaid Services to gain anti-fraud insights using enhanced analytics.

Also See<\/b>: 3 ways to curb fraud with advanced analytics<\/a>

\u201cWe\u2019re really able to share important information about risk areas and about the kinds of things we see both on the private and the public side. So, we\u2019re able to catch various schemes much earlier than we had been able to in years past,\u201d added Levinson.

He noted that home health services is a growing area of healthcare that requires more attention and focus for fraud detection. Levinson referenced the recent Texas case of Jacques Roy, MD, who orchestrated a massive Medicare fraud scheme by submitting $375 million worth of bills for bogus home health services.

\u201cHome health is now such a large part of what we see\u2014we spend probably $18 billion to $19 billion at HHS on home health agencies for 11,000 different providers,\u201d Levinson concluded. \u201cThere are serious vulnerabilities when it comes to home health because it is more difficult to track.\u201d

At the same time, he said Medicaid program integrity \u201cremains a very significant challenge because as we move more towards managed care\u2014from the standpoint of us as auditors and evaluators\u2014we see a system that is much more opaque than really suits our ability to assure that taxpayer dollars are being used appropriately.\u201d Regulators want to know who HHS is \u201cdoing business with\u201d and \u201cproviders are qualified,\u201d and the \u201cmoney is going to people who deserve those fees.\u201d","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

HHS IG: Technology aids ‘Compliance 2.0’ oversight in healthcare

More for you