Gartner Research

Healthcare Payers Must Take an Enterprise Approach to Fraud and Abuse

Published: 09 November 2011

ID: G00225815

Analyst(s): Christina Lucero , Robert H. Booz

Summary

Fraud and abuse are growing concerns among private U.S. healthcare payers as emphasis increases in the public sector. With a new sense of urgency due to healthcare reform challenges and a sluggish economy, payers must adopt an enterprise strategy to prevent healthcare fraud.

Table Of Contents
  • Overview

Analysis

  • Introduction
  • Technology and Organized Crime Fuel Growth of Healthcare Fraud
  • Fighting Fraud in a Postreform World
  • The Enterprise Approach to Preventing Healthcare Fraud
  • Tools and Techniques Used in Enterprise Fraud Prevention
  • Conclusion

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