According to the North American Fraud Detection Systems report, in North America, fraud losses range from 3% to 10% of every dollar paid for healthcare services in the US. The growth of this market is mainly due to rise in growing pressure on healthcare payers to cut cost and reduce time lags.
With the implementation of anti-fraud or fraud awareness program, payers can save money; besides, the returns on investment are also high for fraud detection systems. IT implementation of fraud detection systems helps integrate department-wise data from the provider, payer, thereby reducing errors and chances of fraud.
However, the US Medicare is hampering the private plans as customers have started shifting to government healthcare plans, therefore discouraging the private healthcare payer plans. The American Medical Association’s 2010 national health insurer report card estimated that one in five medical claims are processed inaccurately. These processing errors cost the healthcare industry an estimated of USD 15.5 billion every year.
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