What Should Health Care Organizations Do to Reduce Billing Fraud and Abuse
Bibliographic Data
| ID | 15745459 |
|---|---|
| Authors | Katherine Drabiak (0000-0002-4034-0160, University of South Florida, corresponding author), Jay Wolfson (0000-0002-7322-7287, University of South Florida) |
| Year | 2020 |
| Volume | 22 |
| Issue | 3 |
| Pages | E221-231 |
| Publication date | 2020-03-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | The AMA Journal of Ethic (JOURNAL) |
| Journal identifiers | ISSN: 2376-6980 • E-ISSN: 2376-6980 |
| Publisher | American Medical Association (PUBLISHER • US) |
| DOI | 10.1001/amajethics.2020.221 |
| PMID | 32220269 |
| OpenAlex | W3009853249 |
| Language | EN |
| Citations received | 2 |
Whether physicians are being trained or encouraged to commit fraud within corporatized organizational cultures through contractual incentives (or mandates) to optimize billing and process more patients is unknown. What is known is that upcoding and misrepresentation of clinical information (fraud) costs more than $100 billion annually and can result in unnecessary procedures and prescriptions. This article proposes fraud mitigation strategies that combine organizational cultural enhancements and deployment of transparent compliance and risk management systems that rely on front-end data analytics
Analytics · Business · Commit · Compliance (psychology · Computer security · Data science · Health care · Incentive · Internet privacy · Medical emergency · Misrepresentation · Public relations · Software deployment · Computer Science · Healthcare cost, quality, practices · Healthcare Policy and Management · Medicine · Pharmaceutical industry and healthcare
| Citations per year | 0.33 |
|---|---|
| Citation span | 2020 - 2023 (4) |
| Highly cited | No |