As fee based Healthcare evolves into managed care, new methods of controlling costs will be a priority for government and businesses trying to avoid waste and fraud. Fee for service and managed care present very different challenges for agencies and businesses concerned about healthcare fraud.
Added to the list of schemes like billing for services not rendered and using more lucrative clinical codes under fee for service, is the incentive to under service people who are enrolled, in order to maximize margins under managed care. Capitation fees (fixed fee for each person covered) offer different incentives for fraud. As our healthcare system transitions from fee for service to managed care, the workload will only increase for those charged with detecting fraud and the need for sophisticated detection tools will increase as well. Ascellon is leading the way with innovative software packages designed to assist the healthcare community in saving money.
