The U.S. healthcare industry can save nearly $16 billion annually by integrating antifraud protections into a national, interoperable health data exchange, according to research unveiled at the AHIMA’s 77th annual conference.
Twin studies commissioned by Health and Human Services (HHS) and conducted by AHIMA contractors suggest that while computer-assisted coding can help thwart fraud, it can also increase the potential for wrongdoing.
“One of the things that was the most surprising to me is that EHRs [electronic health records] can increase exposure to fraud,” said national health information technology coordinator David J. Brailer, MD, PhD, whose office authorized the work.
“One of the lesser-known frauds in healthcare is identity theft in the name of healthcare,” Brailer explained at the San Diego conference.
The AHIMA research cites an estimate by the National Health Care Anti-fraud Association that fraud accounted for at least 3% of healthcare spending, or $51 billion, in 2003, but also mentions that fraud-related losses could run as high as 10%, or $170 billion.
But automated coding software and other fraud-fighting applications could produce a net savings of $15.5 billion per year if properly integrated into a system of interoperable EHRs, the studies show.
Additionally, the research serves to define best practices for fraud prevention and detection for policymakers and healthcare organizations to consider while building a national health information network (NHIN). At the top of the list of 10 principles for preventing healthcare fraud is the declaration, “The Nationwide Healthcare Information Network (NHIN) policies, procedures, and standards must proactively prevent, detest, and reduce healthcare fraud rather than be neutral to it.”
