Paul Crowder

Health care payers use a variety of strategies, tools and solutions to fight fraud, waste and abuse (FWA) in their fee-for-service healthcare claims.  A key component of an effective payment integrity strategy is to focus on your most productive targets:  Who or what should be the focus of your payment integrity program? Here are some things to think abou…

Health care payers use a variety of strategies, tools and solutions to fight fraud, waste and abuse (FWA) in their fee-for-service healthcare claims.  Recently, Pre-Payment prevention of losses has been a popular topic in the payment integrity space.  Why is that, and what is the best way to prevent losses to FWA prior to payment? Here are some things to think about:…

Health care payers use a variety of tools and solutions to fight fraud, waste and abuse in their fee-for-service healthcare claims. Recently, artificial intelligence (AI) and machine learning have become popular concepts in payment integrity. But how can they help reduce your losses to health care fraud, waste and abuse? First, let’s look at what is meant by AI and m…

Health care payers typically focus intently on assuring that they are paying the right health care providers for the goods and services that they should pay for, for the correct price, and for the care of the members or beneficiaries who are entitled to these benefits.  Given the negative impact of fraud, waste and abuse on health care, it’s in every payer’s interest…

Every day I see headline-worthy stories of convictions and legal settlements for fraud and abuse in health care around the world. Many health care payers’ SIUs or forensics teams spend their days “grinding it out” in the fight against health care fraud, waste and abuse — they may only aspire to these kinds of headline results. So how does a health care payer measure…