Healthcare WHETHER THE INCREASING NUMBER OF FRAUD ACTIVITIES IS CHANGING THE VIEW POINT OF HEALTHCARE INDUSTRY


WHETHER THE INCREASING NUMBER OF FRAUD ACTIVITIES IS CHANGING THE VIEW POINT OF HEALTHCARE INDUSTRY

Healthcare is important in every people’s live and it demands for affordability. The healthcare industry is a complex system with numerous moving components. It is increasing at a faster pace. Along with time fraud activities in this industry is turning into a crucial problem. One of the issues is the misuse of the medical insurance systems. Manual detection of frauds in the healthcare industry is a complex work. Presently the emergence of machine learning and data mining softwares are employed for automatically detecting the healthcare frauds. 

Types of fraudulent activities in healthcare units:

Frauds by the service providers:

  • The service providers may bill for those medical services that are not even performed during the treatment.
  • These service providers can make the bills for each stage of a medical procedure as if it were a separate treatment, this type of fraud is usually called as Unbundling.
  • Just to generate additional money from insurance payments, service providers may perform unnecessary medical services which may not be essential for the patients, also sometimes they may bill the patients for expensive medical services without any prior intimation.

Fraud by Insurance Subscribers:

  • Just to obtain the insurance premiums at a lower rate, the healthcare insurance company can show the false records about the employment and eligibility.
  • To claim the insurance benefits, these providers may use some other persons details of coverage or insurance card, also they claim for medical services which may not be actually received.
  • Also, there are frauds done by a large group of people which is mainly called as conspiracy frauds. The group compromises of doctors, compounders, and insurance companies.  

Emergence of machine learning:

Healthcare fraud detection solutions plays a vital role when it comes to insurance claims, as most of the fraud cases occur while claiming for the insurance policy. Machine learning softwares help in enhancing the predictive accuracy and enabling loss control units to achieve bigger coverage with low positive rates. Machine learning permits for creating algorithms that process huge datasets with many variables and help find these hidden correlations between user behavior and the likelihood of fraudulent actions. 

Closure:

Looking towards the surging number of healthcare fraud activities across the globe and in different health insurance industry is creating a serious environment in the regions. Health care fraud activities results in financial gain for the drug manufacturers and loss for the patients. The frauds and malpractices in the healthcare industry is found to be rising at a faster rate and almost the fraud activities are different in patterns, that is why it makes harder to detect the frauds. Emergence of different types of software can help to detect and solve the problems immediately. 

Healthcare Fraud Analytics Market: 33.4% CAGR

Projected Revenue: 6.21 billion from 2021 to 2027

For deeper dive check the full report here: https://whipsmartmi.com/Report/Healthcare-Fraud-Analytics-Market

Published Date : March-2021