In an interview released on the website SmartBlog on Leadership, National Health Care Anti-Fraud Association (NHCAA) CEO Louis Saccoccio shared his thoughts on fraud prevention in 2014 and what NHCAA plans to focus on in the coming year.
Saccoccio noted that more payers, both on the private side and in government programs, are turning toward data analytics rather than the traditional "pay-and-chase" model of enforcement. Data analytics will play a big role in 2015, Saccoccio said, along with information sharing.
Last year, Saccoccio spoke with FierceHealthPayer about deciphering claims data in order to uncover a broader picture of billing practices, while mining for red flags and abnormalities. He also emphasized the benefit of learning from existing data to prevent future fraud.
"Predictive modeling creates a positive feedback loop where the data get better and the fraud prevention models more sophisticated," Saccoccio told FierceHealthPayer.
He also told SmartBlog that, although data analytics is an important addition to fraud prevention, it can't replace adequate human resources with the "medical, investigative and analytical expertise" that can effectively fight fraud.
"Payers still need to make the investment to make sure they have the right human resources to get this work done," he said.
- read the interview