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Cassidy, MPA, RHIA, FAHIMA, FHIMSS With the right planning, health IT and nationwide health data exchange can deter healthcare fraud. Fraud is a significant drain on the US healthcare system. The National Health Care Anti- Fraud Association estimates that 3 percent of the nation's annual healthcare outlay- -$5. Other estimates by government and law enforcement agencies place the loss as high as 1. Healthcare fraud is a serious and growing crime nationwide, linked directly to the nation's increasing healthcare outlay. Fraud is a moving target, shifting to new and more sophisticated schemes to mask aberrant behavior. Efforts to reduce fraud, waste, and abuse in Medicare, Medicaid, and the Children’s. This centralized approach has enabled CMS to pursue a more strategic and coordinated set of program integrity policies and activities across the Federal health on. Medicare Program Integrity: Activities to Protect Medicare from Payment Errors, Fraud, and Abuse Cliff Binder Analyst in Health Care Financing. For this reason, fraud control must be highly dynamic. Fraud management is made all the more imperative by federal efforts to promote a nationwide health information network (NHIN) that would link health data among providers and payers across the country. It also creates new potential. In June 2. 00. 5 the Office of the National Coordinator for Health Information Technology contracted with AHIMA's Foundation of Research and Education to conduct research assessing the potential of health IT to expand or enhance healthcare anti- fraud activities. The project's primary objective was to identify best practices that would enhance the capabilities of a nationwide interoperable health IT infrastructure to assist in healthcare fraud prevention, detection, and prosecution. It identified tremendous potential to reduce healthcare fraud and achieve substantial financial benefits through an NHIN and the interoperable electronic health records that would comprise it. The Healthcare Fraud Problem Fraud in healthcare is defined independently by a number of legal authorities, but all definitions share common elements: a false representation of fact or a failure to disclose a fact that is material to a healthcare transaction, along with some damage to another party that reasonably relies on the misrepresentation or failure to disclose. Only a small percentage of the estimated 4 billion healthcare claims submitted each year are fraudulent. Taken in total, however, the resulting cost is high, and the scope of activity is wide. Fraud takes many different forms, such as incorrect reporting of diagnoses or procedures to maximize payments, fraudulent diagnosis, and billing for services not rendered. It has become a career path of choice for criminals looking to reduce risk while increasing returns. The Centers for Medicare and Medicaid Services project national health expenditures to reach $3. One of the most significant impacts is the new Medicare Part D prescription drug benefit, which took effect in January of this year. Strengthening Fraud Control through Health IT Technology can play a critical role in detecting fraud and abuse, and it can help enhance fraud management programs. While technology cannot eliminate the fraud problem, it can significantly minimize fraud and abuse and ultimately reduce healthcare fraud losses. The use of advanced analytics software built into an NHIN will be critical to fraud loss reduction. The federal government continues to expand its initiatives to uncover healthcare fraud, waste, and abuse. It is particularly important that they develop corporate cultures that foster ethical behavior. Many healthcare organizations are doing so through the adoption of corporate compliance programs. Further, a nationally accepted definition of the legal health record will be a crucial component in combating fraud. Currently there is no single definition of the legal health record; state laws and regulations differ regarding record format, content, and retention. In some states, electronic formats are not permitted. A national standard for the legal health record would enable the use of advanced analytics software on an NHIN to prevent, detect, and prosecute fraud. There is also no definition that encompasses the more complex electronic environment and various hybrid situations between paper and electronic records. The interoperability of EHRs offers major improvements in fraud management efforts. Interoperability between payers and providers will enable validation of a clinical encounter between the provider and the patient. When claims data can be electronically linked to encounter data, payers can validate claims prior to payment. Thus interoperable EHRs will help transform fraud management from a . NHIN Benefits in Stages An NHIN's greatest potential for deterring fraud will come in its advanced implementation, with fully interoperable EHRs and integrated advanced fraud- control tools. The research envisioned four states through which the NHIN will evolve: The status quo, as it is anticipated to be in 2. Medicare Part D prescription benefit. In this state, there is no NHIN. Some EHRs and electronic transactions such as e- prescribing exist, but with the exception of claims and prescription databases, there is little aggregate clinical data and no interoperability. In this state, electronic clinical transactions such as laboratory results and e- prescribing become widespread. EHR adoption increases, but there remains little EHR interoperability among providers. This state features interoperability with intelligent coding tools that search for fraud. A record locator system facilitates the exchange of clinical records among providers. Clinical vocabularies are in widespread use, ICD- 1. Advanced analytics exist in this state. Interoperability enables the aggregation of rich clinical and financial databases to which advanced analytic techniques are applied to detect patterns of fraud. There may be substantial savings in fraud- related expenditures that are possible from a move to this state that are not realized in the status quo and early NHIN states. Next Steps Fraud harms everyone in healthcare. The principles presented in . At a minimum, the next steps for consideration include: Defining a single definition of the legal health record across the country Defining the infrastructure components that must support the legal record for both patient care and as admissible evidence in fraud management Defining the standards for EHR process and data standards that both facilitate fraud management and prevent abusive and fraudulent behavior Adopting national metrics for healthcare fraud management to systematically gauge and reduce healthcare fraud Raising awareness of the importance of coordinated fraud management across all stakeholders Continuously revising and updating the NHIN economic model presented here HIM professionals will have a critical role in healthcare fraud control. For more on the HIM role, see . The research behind the finds reported here consisted of five components: Executive committee. FORE convened an executive committee to identify the best opportunities to strengthen the fraud management capability of a nationwide interoperable health IT infrastructure. Findings from the review were used to develop the data collection tool for the site visits and interviews and to formulate and validate the discussions associated with the development of the guiding principles and recommendations. Site visits and interviews. Site visits, in- person interviews, and telephone interviews were conducted using a structured data collection instrument. Telephone and in- person interviews were conducted with approximately 1. Executive committee work groups. Five working committees of the executive committee were established to develop guiding principles and recommendations related to the following five core areas of focus: guiding principles, law enforcement and prosecution, fraud management, information technology infrastructure and implementation, and economic impact. The principal research question for the economic framework asked, . The full report includes further background on the study methodology and greater detail on fraud costs and estimated benefits. The economic model is presented in greater depth. The full report may be read online at www. Guiding Principles The following principles and recommendations offer a road map to ensure that design of an NHIN deters fraud and enables cost- saving anti- fraud activities. They are based on a solid understanding of the vulnerabilities of the healthcare system to individuals with the intent to defraud and the opportunities that well- designed health IT offers. They are intended to guide policy makers and to support the needs of the vast majority of service providers who are striving to comply with laws and requirements that affect billing and reimbursement. NHIN policies, procedures, and standards must proactively prevent, detect, and support prosecution of healthcare fraud rather than be neutral to it. EHRs and information available through the NHIN must fully comply with applicable federal and state laws and meet the requirements for reliability and admissibility of evidence. A standard minimum definition of a legal health record must be adopted for EHRs. Comprehensive healthcare fraud management programs must enable rather than inhibit nationwide EHR adoption. Healthcare fraud management is the responsibility of all healthcare stakeholders. We invite you to join us today! 36 Responses to Patch ignored early advice about one journalist-per-town model. PATCH is Hawaii's only statewide child care resource and referral agency and is a member of: PATCH ECE JOBS MARKET Seeking work in a preschool or. JournalismJobs.com has job listings for online media, newspapers, tv, radio, magazines, nonprofits, and academia. Patch, New York, New York. 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