Managed Healthcare Executive January 26, 2023
Telehealth, especially for behavioral health, has created new opportunities for dishonest individuals to file fraudulent claims. Health plans can take steps to stop the fraud before it happens.
A recent Kaiser Health News investigation uncovered breakdowns in federal safeguards to prevent fraud, waste and abuse (FWA) in Medicare and Medicaid claims, noting that systems intended to prevent repeat offenders from exploiting government programs often failed. Many of these difficulties apply equally to private payers, who may not have access to the data necessary to prevent bad actors from submitting inappropriate claims. Amid the challenges of the ongoing COVID-19 pandemic, one significant area of opportunity is minimizing FWA in behavioral telehealth.
Behavioral health visits are up more than 16% over pre-COVID-19...