Healthcare Transformation

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Fraud and Abuse – In the Spotlight

By Janice Young

Provisions of the Patient Protection and Affordable Care Act (PPACA) of 2010 cast a spotlight on FWA in the health insurance industry and increase incentives for health plans to expand the use of FWA solutions. However, staffing cuts were announced this week by the Department of Health and Human Services (DHHS) Office of the Inspector General, responsible for investigating waste, fraud and abuse. Facing the loss of 20 percent of its workforce compared to last year's level, the office will scale back fraud and abuse investigations. This changes market dynamics for healthcare payers, a number of whom in 2013 reported to IDC Health Insights that they did or intended to piggy-back DHHS initiatives for major fraud and abuse strategies.

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