Is healthcare fraud costing your company?

This article is sponsored by Fullerton Health.

Ted Minkinow, chief information officer, Fullerton Health, calls out the need to minimise healthcare waste through technology that can identify and correct healthcare fraud and errors efficiently.

Approximately US$700 billion is lost annually due to fraud, waste and abuse in the US healthcare system, a third of total healthcare spending.[1]

While the corresponding figure for the region is currently unavailable, ASEAN’s total healthcare spend of over US$68 billion,[2] the market fragmentation, regulatory changes and urban-rural divides suggest healthcare fraud and waste in the region potentially amounts to billions.

To put this into perspective, medical fraud dwarfs the largest bank robberies in history combined.

Much of this cost is ultimately borne by patients, their families and companies paying for corporate health programmes as such inefficiencies increase healthcare and insurance costs.

The responsibility falls to HR professionals to ensure that their companies are not losing money due to healthcare fraud and waste – each dollar invested into your employees’ health should go towards improving their health and wellbeing.

Here, we must note that a lot of healthcare waste arises unintentionally from errors and may not be due to fraud; it may be happening right under our noses even with the best of intentions. Some of the common reasons for healthcare waste include over-prescription, phantom billing and errors due to weak internal processes.

One of the most effective ways to minimise healthcare waste is through technology, which can help identify and correct healthcare fraud and errors efficiently.

For example, Fullerton Health continually invests in innovation in technology which improves security of our databases and offers a richer suite of data analytic tools, providing strong foundations for weeding out fraud and errors in healthcare transactions.

Another revolutionary feature that technology offers today is machine learning, where we can "train" the system to detect fraud and errors more accurately and quickly over time. Having implemented machine learning data analytics for eight months now, we have found it to be effective in detecting errors that could save a significant portion of a company’s and country’s healthcare budget each year.

Since Fullerton Health’s founding, we have fostered a culture of relentless innovation in support of our mission: to transform healthcare in Asia, and make it affordable and accessible to those we serve. We see technology as the key enabler in making this happen and we continue to search for opportunities to use technology to improve the quality of service we provide our patients and customers.

While we cannot hope to eliminate fraud and errors from all medical transactions, we aim to eliminate them from all Fullerton Health transactions. It is everyone’s responsibility to be mindful of such healthcare waste so that we can tackle it together.

HR professionals, who are responsible for employees’ healthcare benefits, recognise that healthcare waste does not impact just insurers, or patients, but also all aspects of the healthcare value chain, including their company.

[1]Fierce Healthcare (26 Oct 2009), ‘Waste in the U.S. healthcare system pegged at $700 billion’. Available at: http://www.fiercehealthcare.com/healthcare/waste-u-s-healthcare-system-pegged-at-700-billion

[2]Deloitte (2015), ‘A perspective of future healthcare landscapein ASEAN and Singapore’. Available at:  https://www2.deloitte.com/content/dam/Deloitte/sg/Documents/risk/sea-risk-future-healthcare-thought-leadership-noexp.pdf

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