Claims Fraud

Healthcare Insurance  ·  5 min read

Healthcare Fraud Detection: Why Paying First and Recovering Later Is a Strategy That Does Not Work

Industry estimates put Fraud, Waste, and Abuse at 10 to 15 percent of total healthcare spend. Pre-payment detection is five to ten times more cost-effective than post-payment recovery. Most health plans still detect the majority of fraud after the claim is paid. The shift to pre-payment detection is not a technology preference. It is an economic imperative.