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Truven Health Analytics Identifies Most Costly Sources of Healthcare Fraud

ANN ARBOR, Mich.–(BUSINESS WIRE)–Healthcare fraud is not limited to the Medicare and Medicaid population. According to a new analysis of commercial insurance claims data conducted by Truven Health Analytics, six common claims scenarios accounted for nearly a million dollars in overpayments annually for each of the organizations in the study.

The new Payment Integrity Analysis augments previous research conducted by Truven Health Analytics, which found that $125-$175 billion in annual healthcare spending is attributable to fraud and abuse in the publicly-and privately-insured population. Using the Truven Health MarketScan® Commercial Database, the new study analyzed insurance claims data for 11.6 million commercially insured individuals and their dependents at 150 large employers over a period of one year. Researchers then identified six types of fraudulent or wasteful claims that contribute the greatest amount of unnecessary healthcare expenditure each year.

“This analysis of real-world health claims data is critical because it cuts through the rhetoric to shine a spotlight on the specific instances where fraud, waste, and abuse are increasingly visible to us,” said Mike Boswood, Truven Health Analytics president and CEO. “By screening vast volumes of healthcare claims data against best practices and quality guidelines, it is possible to consistently spot anomalies and begin the process of rooting out fraud and abuse at the source.”…read full article

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