Best Practices for Healthcare Payers Addressing Fraud, Waste and Abuse

Archived Published: 02 February 2015 ID: G00273112

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Fraud, waste and abuse cost the U.S. healthcare system more than $60 billion every year. Healthcare payer CIOs can address this growing problem by improving awareness, increasing oversight and applying better technologies.

Table of Contents

  • Introduction
    • Fraud, Waste and Abuse: A Business-Critical Problem for Healthcare Payers and Their CIOs
  • Analysis
    • Develop a Comprehensive FWA Strategy
      • Real-World Issues in Developing the Strategy
    • Implement an Iterative, Multilayered Approach to Pre- and Postpayment Investigation
    • Create a Dedicated SIU
  • Gartner Recommended Reading
© 2015 Gartner, Inc. and/or its Affiliates. All Rights Reserved. Reproduction and distribution of this publication in any form without prior written permission is forbidden. The information contained herein has been obtained from sources believed to be reliable. Gartner disclaims all warranties as to the accuracy, completeness or adequacy of such information. Although Gartners research may discuss legal issues related to the information technology business, Gartner does not provide legal advice or services and its research should not be construed or used as such. Gartner shall have no liability for errors, omissions or inadequacies in the information contained herein or for interpretations thereof. The opinions expressed herein are subject to change without notice.

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