ONCHIT Awards Anti-Fraud Grant to RTI

As part of an effort to identify and prevent health care fraud, RTI International was awarded a six-month project, worth almost a half-million dollars by the Office of the National Coordinator for Health Information Technology. Under terms of the contract, RTI researchers will work with the American Health Information Management Association (AHIMA) and SPSS to take a proactive approach to preventing health care fraud.

The company will develop functions and requirements for healthcare anti-fraud data collection in electronic health records (EHR), and the submission, compilation.
It's hoped that analysis of such data that can be used to reduce the growing number of fraudulent claims and other improper payments against public and private health care plans.

"Currently, most fraud is detected post payment, which makes dealing with the claims very inefficient," said Colleen McCue, Ph.D., a senior research scientist at RTI and project manager. "If we can detect errors at the time the record is created, we can not only eliminate improper payments, but also improve the quality of care."

The research team will work with the National Health Care Antifraud Association (NHCAA), health care providers, health insurers, federal agencies, the Health Information Technology Standards Panel (HITSP) and the Certification Commission for Health Information Technology (CCHIT) to develop model anti-fraud requirements for electronic health records that will prevent, detect and support the prosecution of health care fraud as well as minimize opportunities for fraud.

"In some areas of the country, criminals have actually switched from drug trafficking to committing fraud against health care plans, because they consider it safer and more profitable," McCue said. "The model requirements that we propose will help officials predict when and how fraud may occur so they can manage resources and reduce its incidence."

Current estimates suggest that 3 to 10 percent of the annual U.S. health care expenditures are fraudulent. In 2001, the HHS Office of Inspector General found that $12.1 billion in Medicare fee-for-service claims should not have been paid.

Click here to log in.


Add Comment

Text Only 2000 character limit

Page 1 of 1

White Papers & Special Reports

Wiley Chem Planner Synthesis Solved
Sponsored by Wiley

SGI and Intel
HPDA for Personalized Medicine
Sponsored by SGI and Intel

Life Science Webcasts & Podcasts

medidata_podcast_Sites and Sponsors: Mending Bridges over Troubled Waters  
Sites and Sponsors: Mending Bridges over Troubled Waters
Sponsored by Medidata Solutions Worldwide

This podcast brings together two industry leaders to focus on the issues that divide sponsors and sites. On the one hand sites and sponsors unite in advancing better health care through a common passion for developing better drugs. Yet some issues divide them and bridges need to be built or mended to advance the highest levels of cooperation, coordination and success in clinical trials. Listen as the key issues are debated from the site and the sponsor side and new methods and technology are advanced that offer near-term and lasting solutions.

• Common ground in reaching agreement on a budget

• Improving the pace of agreement on budgets and contracts

• Processes for payment to sites on a timely basis

Listen Now  

More Podcasts

Job Openings

For reprints and/or copyright permission, please contact Angela Parsons, 781.972.5467.