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David Lareau is CEO of Medicomp Systems, which makes medical data relevant, usable and actionable.
A couple of years ago, I predicted a “coming explosion” of Medicare Advantage (MA) fraud and penalties—and we’re now seeing it happen. In fact, recent investigations have uncovered a troubling trend in MA programs: Widespread fraud is costing taxpayers billions. The Wall Street Journal’s exposé revealed that “insurers pocketed $50 billion from Medicare for diseases no doctor treated.” This isn’t just a matter of paperwork errors; it’s a systemic issue that affects people’s lives and the sustainability of our healthcare system.
And the reactive approach isn’t working.
The current approach to combating Medicare fraud seems to be, “If your organization is committing fraud, come tell...
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