The Problem

Simply put, the problem is fraud in healthcare. But what is "fraud in healthcare", what type of fraud are we facing?

Phantom Billing - This is billing for services that were not provided, billing for services to persons accompanying a patient who did not receive any medical services, or billing for office visits that never occurred.

Card Swapping - This occurs when a patient receives treatments using another person's medical information.

Up-coding - This involves billing for more expensive treatments that services actually provided during a patient's visit.

Medical Identity Theft - This involves someone pretending to be someone else by using a person's name or other items such as an insurance card or number to obtain medical services. Medical identity theft can result in incorrect medical records being stored under the victim's name and insurance information.

Each of the above items are problems that result in a larger price tag for everyone; payer, provider and patient. Currently fraud detection is mostly done using computerized statistical analysis or by persons in the industry recognizing and reporting suspicious claims. This is a "pay and chase" methodology, pay the claim then, when fraud is detected, the fraudulent claims must be investigated further to provide proof that the claims are in fact fraudulent and then they can be pursued further. Each step of this process increases everyone's costs even further.

BioClaim™ recognizes more than the problem that fraud in healthcare causes but also addresses the failures of other biometric/smart card solutions. Other biometric companies claim they eliminate fraud using a biometric device but rely on the receptionist/front desk personnel to stop a fraudulent transaction if the biometric validation does not match. There is no record of the biometric validation that occurred during the visit leaving the payer to continue to rely on the "pay and chase" method.

So what can you do? Let BioClaim™ assist in eliminating fraud for your business. Give Fraud the Finger.

Did you know?

According to the Center for Medicare and Medicaid Services, CMS, healthcare spending in 2007 in the US amounted to 2.3 trillion dollars. This figure is expected to increase to 3.8 trillion dollars by 2014.

Source Fraud Estimate
Congressional Budget Office 10%
General Accounting Office 10%
National Health Care Anti-Fraud Association 3-10%
U.S. Chamber of Commerce 10%

Most governmental and insurance agencies estimate the fraud at around 10% of total expenditures.

Learn More About Healthcare Fraud