Healthcare Experts Offer New Medical Fraud Detection and Prevention Capabilities

November 16, 2021 — Carson City, Nevada – No World Borders, a company of experts in healthcare data, regulations, and economics, announced new capabilities for its management consulting and litigation consulting practice.

Healthcare fraud costs U.S. Taxpayers $billions every year. According to The National Health Care Anti-Fraud Association, $3.6 trillion was spent on healthcare in the United States in 2018, and the financial losses due to health care fraud are in the tens of billions of dollars each year. Estimates range from 3% of total health care expenditures, while some government and law enforcement agencies place the loss as high as 10% of our annual health outlay, which could mean, conservatively, at least $100 billion in 2018 alone.

For decades, fraud detection and prevention elude the medical industry

According to Michael Arrigo, "Detection and prevention fraud has eluded the healthcare industry for decades. Skilled analytics and medical billing expert witness capabilities can help all parties in the health care value chain."

Healthcare data analytics and insurance claim processing experts

Mr. Arrigo continued, "For health care providers, ensuring accurate clinical documentation, medical coding, and medical billing ensures reliable reimbursement. For health plans and self-insured employers, skilled experts in medical coverage determinations and medical policies can ensure that the system's rules or 'edits' meet the health plan's policies. For all stakeholders, data analytics can be used to ensure that coding, billing, and payment patterns meet expectations."

Specific Expertise in Medicare and Private Insurance Billing

The Company also offers expert guidance with Medicare Local Coverage Determinations, also known as Medicare LCDs is essential when the scope of an engagement includes Medicare or Medicaid providers, beneficiaries, or allegations of fraud.

Capability to Perform Electronic Health Record Forensic Reviews
In situations where the accuracy of clinical documentation is contested, electronic health record forensic audits may be useful.

Usual Customary and Reasonable Charges using Medical Billing Experts
In personal injury cases, medical care may be billed on a hospital lien. Determination of the Usual Customary and Reasonable charges may be useful in determining the value of medical care.

Healthcare data privacy and cyber security experts, breach damages
At times, data privacy issues are also contested. The company offers expertise from HIPAA Expert Witness testifying experts that can opine regarding the HIPAA Privacy Rule and the HIPAA Security Rule as well as state privacy Standards and damages in breach cases.

Medicare fraud damages and loss calculation by damages experts and expertise in Medicare Data Standards

Workers compensation, automobile insurers, property insurers and self-insured plans (regulated by the Employee Retirement Income Security Act of 1974 or ERISA) are subject to the Medicare Secondary Payer Act. The company brings expertise in the MSPA and related disciplines to help recover federal taxpayer funds that were not reimbursed by Non-Group Health Plans (NGHPs) who are Responsible Reporting Entities (RREs) to Medicare.

Finally, Medicare fraud damages experts and a medical billing expert witness may be useful in commercial insurance fraud damages experts can assist in quantifying the intended loss and actual loss to a health plan.

About No World Borders - Experts in Healthcare Data Regulations and Economics

No World Borders provides a clinically integrated intelligence to inform clients across the silos in healthcare. The company was provided solutions to health plans, health care payers, law firms, private equity and venture capital firms, and philanthropic organizations for nearly two decades. For more information about company news coverage, see: https://noworldborders.com/news/
For more information, contact Michael F Arrigo at www.noworldborders.com at 949-335-5580