In 2020, the Department of Justice estimated that fraudulent, wasteful, and abusive (FWA) billing practices account for more than $100 billion of the nation’s healthcare expenditures.1 Today, the National Healthcare Anti-Fraud Association (NHCAA) conservatively estimates that healthcare FWA costs the nation about $68 billion annually, representing 3% of the nation's $2.26 trillion in healthcare spending.2 FWA estimates from commercial health plans range as high as $230 billion annually, or
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integrity
M&A: MultiPlan Acquires Benefits Science LLC for $160M
What You Should Know: MultiPlan, a provider of data-enabled cost management, payment, and revenue integrity solutions for 700+ healthcare payors announced the acquisition of Benefits Science LLC (BST) for $160M in cash and stock.BST was founded in 2012 by a group of MIT-trained experts in data science, including Dimitris Bertsimas, Ph.D., who is recognized as an early pioneer in healthcare analytics and who serves as the company’s chief data scientist. Dr. Bertsimas will continue with BST
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What Is A HIPAA-Compliant Infrastructure?
U.S. healthcare companies must comply with the data security and privacy standards defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The purpose of the legislation is to safeguard the privacy and security of protected health information (PHI) and electronic protected health information (ePHI). Failure to comply with HIPAA regulations can result in serious financial fines and reputational damage. What Determines HIPAA Compliance? Organizations
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Sagility Acquires Payment Integrity Provider DCI Consulting
What You Should Know: Sagility, a provder optimizing the member/patient experience and business process management acquires Chandler, Arizona-based Devlin Consulting, Inc. (DCI), an established healthcare technology services company with nearly 30 years of payment integrity experience.The acquisition represents Sagility’s first acquisition since unveiling its new identity as an independent U.S.-based company solely dedicated to the healthcare industry following the 2021 divestment from HGS.
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The Future of Digital Transformation in Hospitals
Hospitals are increasingly motivated to drive digital transformation in order to improve patient outcomes, reduce costs, meet regulatory requirements and stay competitive. Additionally, digital transformation can support medical research and drive innovation in healthcare, as well as generate new revenue streams. An increasingly important tool as hospitals undergo these transformations is federated learning, a technology that we will expand on later. Federated learning is a machine learning
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Survey Reveals 94% of Leaders to Invest in Software/ 90% Admit to Lost Data
What You Should Know: Intelligent Medical Objects (IMO), a healthcare data enablement company, conducted a survey of more than 300 provider leaders who are responsible for implementing and purchasing technology at healthcare provider organizations. The survey, titled ‘Intelligent Insights: Data challenges, tech investments, and shifting provider priorities’ uncovered many surprising findings and some seemingly universal truths about the challenges U.S. provider organizations are facing and
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How Hospitals Can Safely & Effectively Continue Patient Care Amid Rising Cybersecurity Risks
The world we live in is becoming increasingly integrated, and as it does, the amount of data also increases. It is estimated that 2.5 quintillion bytes – that’s 2,500,00,00,000 million, for perspective – are created, captured, and shared every day, and experts predict that number will grow exponentially in the coming years. Estimates show that the healthcare industry generates about 30% of the world’s data volume. That number is expected to reach a compound annual growth rate of 36% within the
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CMS Program Integrity’s Role in Combatting FWA While Maintaining Health Equity
In 2022, the Center for Medicare and Medicaid Services (CMS) established health equity as a pillar of its future work. Program integrity staff from every state Medicaid program, and federal program staff working on Medicare, must consider the roles of both program integrity and analytics when combatting fraud, waste, and abuse (FWA)in the healthcare system. CMS defines health equity as "the attainment of the highest level of health for all people, where everyone has a fair and just
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Top Security Certifications Required for Data Protection
How secure is your data? If your organization does not have the right security certifications in place, it’s not a matter of if a data breach will occur – but when. A lack of regulatory compliance, network and technical vulnerabilities, unencrypted information, unsecured mobile devices, and weak credentials all play a part in putting a healthcare organization at risk for a data breach. Today, the cost of a data breach comes with a hefty price tag – an average of $9.44 million in the
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Epic, Impact Advisors, Nordic, Chartis Named 2023 Overall Best in KLAS® Awards
What You Should Know: Epic, Nordic, Impact Advisors and The Chartis Group won the 2023 Overall Best in KLAS® awards. Epic was named the top Overall Software Suite for the thirteenth straight year in 2023 Best in KLAS – Software & Services report, released, which reports on the top vendors for 2022. Epic was also named the top Overall Physician Practice Vendor. Epic won thirteen other Best in KLAS awards in various market segments. - Impact Advisors tied with Nordic to be a
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