Next-Generation Healthcare Fraud Management

Moving from “pay and chase” to pre-pay identification

Technology for addressing fraud, waste, and abuse (FWA) in healthcare claims has changed exponentially over the past 25 years. Paralleling this advance in technology has been the increasing speed and sophistication of healthcare fraud tactics and techniques. Both growth curves reflect a focus on a retrospective “pay and chase” model that identifies and recovers FWA after payment is made. This paper presents the preferred method of addressing FWA, pre-pay identification and prevention, now enabled by technology advances in analytics, cloud, security and collaboration.

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