GHCAN in the News: Fraud in Healthcare: A Worldwide Concern

Simon Peck and Leigh McKenna of GHCAN were interviewed by HealthManagement magazine on the range and scope of healthcare fraud globally.

From the HealthManagement news article:

The Global Health Care Anti-fraud Network (GHCAN) promotes partnerships and communications between international organisations in order to reduce and eliminate healthcare fraud around the world. HealthManagement spoke to representatives, Simon Peck (SP; UK), and Leigh McKenna (LM; USA) to find out more.

{ snip }

SP: In the UK we estimate fraud in the private sector to be about 5% of claims paid. In any environment, only a small number of people are fraudulent by nature—many more go along with the culture, and we have worked hard to raise awareness and try to send the message that such activity is unacceptable. There is no evidence that fraud has become more sophisticated in the UK. The response has, however, as we have sought to learn from our partners in the U.S. Insurers have become a lot more capable with the use of technology to highlight problems, professional investigators and other skills

{ snip }

LM: Fraud trends and schemes are constantly changing, developing, shifting, migrating and morphing, and the task for anti-fraud professionals to stay ahead of the threat is daunting. Some frauds are impressively sophisticated while others are remarkably absurd. And in many cases—such as with phantom providers—speed is the key. Someone who sets up a false storefront with the intention of filing false claims, will submit many claims, receive payment and abandon the property before investigators are able to intervene.

Download the PDF version of the article here, or read it online at the link:

About Author: GHCAN Admin

Comments are closed.