In 2015, improper payments were an estimated $72 billion within Medicaid and Medicare alone, despite the industry’s best efforts to apply utilization management, claim editing, and other initiatives. Whether in government or commercial health insurance, the majority of this loss does not come from schemes and scams. Rather, the primary culprits are mundane billing waste and abuse—issues that by their very nature can easily hide in plain sight.
Our latest infographic explores how common healthcare billing practices can bypass an auto-adjudication system, totaling millions in potential fraud, waste, and abuse (FWA) payments. In 2016 alone, for our clients:
- Unbundling represents the greatest share of coding errors in 2016 with over $96.2 million in identified prevented payments
- Inconsistent billing practices have been identified 45,000 times with avoided payments in excess of $4.2 million
- Duplicate claims have represented 12 percent of billing errors and totaled over $21 million in in avoided payments