According to the latest statistics, health insurance companies can save over $100 per member per year. A common return on investment (ROI) is around 1,000%. This means that for every Dollar spent on fraud, waste and abuse initiatives they save about ten to eleven Dollars.
AMG-SIU saved one of their clients $210,000 by performing an audit on DRG usage. The audit uncovered that many providers were using wrong DRG codes for newborn babies. Correcting the affected claims saved the health plan over $210,000.
As expected, CMS was not able to disseminate the National Provider Identifier (NPI) data in a usable format, even after delaying the release multiple times. The first version of the downloadable file contained the text qualifier in the data. Also, there is no free version of the taxonomy codes. The data is only published as a PDF. Companies are forced to purchase a copy of a usable file.
It is ridiculous that the government forces companies to comply with their rules and regulations but is unable to provide the means to do so.
AMG-SIU is participating in local CEO and CIO roundtables such as the CEO and CIO Roundtables by TechBizConnection and the CIO Roundtables at the Claremont Graduate University (CGU).
In an article called “Slicko“, Forbes reports that most health insurances spend about 20% too much on medical claims due to fraud, waste and abuse.
In their opinion, this is a bigger problem than the wrongful denials mentioned by Michael Moore in his movie “Sicko”.
AMG-SIU discovers lots of problems in different areas, including ineligible members, not covered services and duplicate claims mentioned in the article.
AMG-SIU not only ensures the accuracy of edits, but also provides backup for their denials.
The latest statistics estimate the amount of healthcare fraud at $60 Billion. This huge amount mainly includes Medicare and Medicaid. It does not include fraud, waste and abuse on commercial and self-funded health plans.
Effective May 21, 2007, AMG-SIU and M*D Resources, a national consultant to health care facilities and health care organizations, became strategic partners in bringing fraud, waste and abuse detection services to the health care industry.
AMG-SIU started processing CHIP Perinatal claims after the program was launched by the State of Texas.
The Federal Bureau of Investigation (FBI) was thanking AMG-SIU for their support (letter from the FBI). The FBI is also looking forward to combating healthcare fraud in cooperation with AMG-SIU.