Accessibility Statement Skip Navigation
  • Why PRWeb
  • How It Works
  • Who Uses It
  • Pricing
  • Login
  • GDPR
  • Create a Free Account
Return to PRWeb homepage
  • News
  • Resources
  • Contact
When typing in this field, a list of search results will appear and be automatically updated as you type.

Searching for your content...

No results found. Please change your search terms and try again.
  • News in Focus
      • Browse News Releases

      • All News Releases
      • Multimedia Gallery

      • All Multimedia
      • All Photos
      • All Videos
  • Business & Money
      • Auto & Transportation

      • Aerospace, Defense
      • Air Freight
      • Airlines & Aviation
      • Automotive
      • Maritime & Shipbuilding
      • Railroads and Intermodal Transportation
      • Supply Chain/Logistics
      • Transportation, Trucking & Railroad
      • Travel
      • Trucking and Road Transportation
      • View All Auto & Transportation

      • Business Technology

      • Blockchain
      • Broadcast Tech
      • Computer & Electronics
      • Computer Hardware
      • Computer Software
      • Data Analytics
      • Electronic Commerce
      • Electronic Components
      • Electronic Design Automation
      • Financial Technology
      • High Tech Security
      • Internet Technology
      • Nanotechnology
      • Networks
      • Peripherals
      • Semiconductors
      • View All Business Technology

      • Entertain­ment & Media

      • Advertising
      • Art
      • Books
      • Entertainment
      • Film and Motion Picture
      • Magazines
      • Music
      • Publishing & Information Services
      • Radio & Podcast
      • Television
      • View All Entertain­ment & Media

      • Financial Services & Investing

      • Accounting News & Issues
      • Acquisitions, Mergers and Takeovers
      • Banking & Financial Services
      • Bankruptcy
      • Bond & Stock Ratings
      • Conference Call Announcements
      • Contracts
      • Cryptocurrency
      • Dividends
      • Earnings
      • Earnings Forecasts & Projections
      • Financing Agreements
      • Insurance
      • Investments Opinions
      • Joint Ventures
      • Mutual Funds
      • Private Placement
      • Real Estate
      • Restructuring & Recapitalization
      • Sales Reports
      • Shareholder Activism
      • Shareholder Meetings
      • Stock Offering
      • Stock Split
      • Venture Capital
      • View All Financial Services & Investing

      • General Business

      • Awards
      • Commercial Real Estate
      • Corporate Expansion
      • Earnings
      • Environmental, Social and Governance (ESG)
      • Human Resource & Workforce Management
      • Licensing
      • New Products & Services
      • Obituaries
      • Outsourcing Businesses
      • Overseas Real Estate (non-US)
      • Personnel Announcements
      • Real Estate Transactions
      • Residential Real Estate
      • Small Business Services
      • Socially Responsible Investing
      • Surveys, Polls and Research
      • Trade Show News
      • View All General Business

  • Science & Tech
      • Consumer Technology

      • Artificial Intelligence
      • Blockchain
      • Cloud Computing/Internet of Things
      • Computer Electronics
      • Computer Hardware
      • Computer Software
      • Consumer Electronics
      • Cryptocurrency
      • Data Analytics
      • Electronic Commerce
      • Electronic Gaming
      • Financial Technology
      • Mobile Entertainment
      • Multimedia & Internet
      • Peripherals
      • Social Media
      • STEM (Science, Tech, Engineering, Math)
      • Supply Chain/Logistics
      • Wireless Communications
      • View All Consumer Technology

      • Energy & Natural Resources

      • Alternative Energies
      • Chemical
      • Electrical Utilities
      • Gas
      • General Manufacturing
      • Mining
      • Mining & Metals
      • Oil & Energy
      • Oil and Gas Discoveries
      • Utilities
      • Water Utilities
      • View All Energy & Natural Resources

      • Environ­ment

      • Conservation & Recycling
      • Environmental Issues
      • Environmental Policy
      • Environmental Products & Services
      • Green Technology
      • Natural Disasters
      • View All Environ­ment

      • Heavy Industry & Manufacturing

      • Aerospace & Defense
      • Agriculture
      • Chemical
      • Construction & Building
      • General Manufacturing
      • HVAC (Heating, Ventilation and Air-Conditioning)
      • Machinery
      • Machine Tools, Metalworking and Metallurgy
      • Mining
      • Mining & Metals
      • Paper, Forest Products & Containers
      • Precious Metals
      • Textiles
      • Tobacco
      • View All Heavy Industry & Manufacturing

      • Telecomm­unications

      • Carriers and Services
      • Mobile Entertainment
      • Networks
      • Peripherals
      • Telecommunications Equipment
      • Telecommunications Industry
      • VoIP (Voice over Internet Protocol)
      • Wireless Communications
      • View All Telecomm­unications

  • Lifestyle & Health
      • Consumer Products & Retail

      • Animals & Pets
      • Beers, Wines and Spirits
      • Beverages
      • Bridal Services
      • Cannabis
      • Cosmetics and Personal Care
      • Fashion
      • Food & Beverages
      • Furniture and Furnishings
      • Home Improvement
      • Household, Consumer & Cosmetics
      • Household Products
      • Jewelry
      • Non-Alcoholic Beverages
      • Office Products
      • Organic Food
      • Product Recalls
      • Restaurants
      • Retail
      • Supermarkets
      • Toys
      • View All Consumer Products & Retail

      • Entertain­ment & Media

      • Advertising
      • Art
      • Books
      • Entertainment
      • Film and Motion Picture
      • Magazines
      • Music
      • Publishing & Information Services
      • Radio & Podcast
      • Television
      • View All Entertain­ment & Media

      • Health

      • Biometrics
      • Biotechnology
      • Clinical Trials & Medical Discoveries
      • Dentistry
      • FDA Approval
      • Fitness/Wellness
      • Health Care & Hospitals
      • Health Insurance
      • Infection Control
      • International Medical Approval
      • Medical Equipment
      • Medical Pharmaceuticals
      • Mental Health
      • Pharmaceuticals
      • Supplementary Medicine
      • View All Health

      • Sports

      • General Sports
      • Outdoors, Camping & Hiking
      • Sporting Events
      • Sports Equipment & Accessories
      • View All Sports

      • Travel

      • Amusement Parks and Tourist Attractions
      • Gambling & Casinos
      • Hotels and Resorts
      • Leisure & Tourism
      • Outdoors, Camping & Hiking
      • Passenger Aviation
      • Travel Industry
      • View All Travel

  • Policy & Public Interest
      • Policy & Public Interest

      • Advocacy Group Opinion
      • Animal Welfare
      • Congressional & Presidential Campaigns
      • Corporate Social Responsibility
      • Domestic Policy
      • Economic News, Trends, Analysis
      • Education
      • Environmental
      • European Government
      • FDA Approval
      • Federal and State Legislation
      • Federal Executive Branch & Agency
      • Foreign Policy & International Affairs
      • Homeland Security
      • Labor & Union
      • Legal Issues
      • Natural Disasters
      • Not For Profit
      • Patent Law
      • Public Safety
      • Trade Policy
      • U.S. State Policy
      • View All Policy & Public Interest

  • People & Culture
      • People & Culture

      • Aboriginal, First Nations & Native American
      • African American
      • Asian American
      • Children
      • Diversity, Equity & Inclusion
      • Hispanic
      • Lesbian, Gay & Bisexual
      • Men's Interest
      • People with Disabilities
      • Religion
      • Senior Citizens
      • Veterans
      • Women
      • View All People & Culture

  • Hamburger menu
  • Cision PRWeb provides efficient communication tools to continuously engage with target audiences across multiple online channels
  • Create a Free Account
    • ALL CONTACT INFO
    • Contact Us


      11AM ET Sunday – 8PM ET Friday

  • Send a Release
  • Sign up
  • Log in
  • Resources
  • RSS
  • GDPR
  • News in Focus
    • Browse All News
    • Multimedia Gallery
  • Business & Money
    • Auto & Transportation
    • Business Technology
    • Entertain­ment & Media
    • Financial Services & Investing
    • General Business
  • Science & Tech
    • Consumer Technology
    • Energy & Natural Resources
    • Environ­ment
    • Heavy Industry & Manufacturing
    • Telecomm­unications
  • Lifestyle & Health
    • Consumer Products & Retail
    • Entertain­ment & Media
    • Health
    • Sports
    • Travel
  • Policy & Public Interest
  • People & Culture
    • People & Culture
  • Send a Release
  • Sign up
  • Log in
  • Resources
  • RSS
  • GDPR
  • Send a Release
  • Sign up
  • Log in
  • Resources
  • RSS
  • GDPR
  • Send a Release
  • Sign up
  • Log in
  • Resources
  • RSS
  • GDPR

Actionable Intelligence Technologies Announces CFIS Technology as a Solution to a Worsening Problem: Healthcare Fraud
  • USA - English


News provided by

JoTo PR

Nov 17, 2015, 13:30 ET

Share this article

Share toX

Share this article

Share toX


Dulles, VA (PRWEB) November 17, 2015 -- Scams against government and private healthcare insurers are the largest types of insurance fraud. While the exact amount of money stolen in this way is unknown, it’s estimated to be in the tens of billions; the National Health Care Anti-Fraud Association puts the total at close to $100 billion per year.1

“Whatever the actual total is,” says Susan Deehan, Chairwoman and CEO of Actionable Intelligence Technologies, the nation’s leading supplier of solutions for financial investigations, “it’s increasing rapidly.”

The size of the prize makes it imperative that we do better—and with the proper technology, we can.

Post this

Per Deehan, the increase in fraud stems from the increase in the nation’s overall healthcare expenditures and fraudulent activity and the size of the annual U.S. healthcare budget, which is a magnet to criminal organizations. Figures from the Centers for Medicare & Medicaid Services show that healthcare expenditures in the U.S. will reach $3.2 trillion in 2015, or about $10,000 per person. In 2014, Medicare spending alone reached $616.8 billion.2

While healthcare fraud is a national issue, there appear to be certain hotspots. The Office of Inspector General released a report in 2012 on the efforts of federal/state Medical Fraud Control Units (MFCUs), which investigate and prosecute fraud, as well as patient abuse and neglect at healthcare facilities. In 2011, MFCUs conducted 10,685 Medicaid fraud investigations, resulting in 824 convictions. Of the convictions, 464 took place in only five states: California, Texas, New York, Ohio, and Kentucky.3

Other government anti-fraud initiatives are also working to apprehend fraudsters and recoup some of the money lost in wrongful payments. According to the Coalition Against Insurance Fraud, over $27.8 billion has been returned to the Medical Trust Fund since the Health Care Fraud and Abuse Program was created in 1997. The Medicare Strike Force was created in 2007, since then it has lodged 1,285 criminal actions and charged more than 2,300 defendants. The Department of Justice has recovered more than $15 billion in healthcare fraud cases over the past five years, and the average prison sentence for Medicare Strike Force cases in 2014 was more than four years. Some prosecutions in recent years have earned sentences up to 50 years.4

Additional tools are made available to fraud fighters by the Affordable Care Act, which provides $350 million over ten years to boost anti-fraud efforts and increases federal sentencing guidelines for health care fraud by 20-50 percent for crimes resulting in over $1 million in losses. In 2009, the fight against Medical fraud became a Cabinet-level priority with the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), which reports to the Secretary of Health and Human Services and the Attorney General.5

Even with these efforts, there are still high rates of fraud in the industry, nearly $80 billion of improper Medicare and Medicaid payments were made in 2014. Of this amount, $60 billion involved improper Medicare payments, which is about 10 percent of the $603 billion spent to provide coverage for 54 million Medicare beneficiaries last year. The $60 billion figure is also the largest portion of the total of $124.7 billion in improper payments across all federal programs.6

In the U.S., recent evidence shows that an increased investment in fraud prevention would yield a significant return. The Healthcare Fraud Abuse and Control Program and its sister initiatives have returned $7.70 for every dollar invested since 1997. The Medicaid Fraud Control Units have performed even better; the office of Inspector General reports that ROI for their initiatives has amounted to $8.39 for every dollar invested.7

“It’s a straightforward business proposition,” says Deehan. “The size of the prize makes it imperative that we do better—and with the proper technology, we can. For example, the financial services industry considers 1 tenth of 1% to be an acceptable level of fraud risk/loss and the industry invests in the necessary resources to achieve that goal. This compares to the fraud estimates in health care industry of more than 10%, some experts think the actual rate of fraud may approach 20%.”

To help strengthen the ability of law enforcement agencies to combat white-collar crime, including healthcare fraud, AIT has developed a tool called the Comprehensive Financial Investigative Solution (CFIS), which allows an investigator to process and analyze financial records exponentially faster and more accurately than with manual methods. Investigators using CFIS technology can perform data entry and analysis in hours and days that would take months and years using conventional methods.

About Actionable Intelligence Technologies:

Headquartered in Dulles, VA, award-winning Actionable Intelligence Technologies is the nation’s leading supplier of solutions for financial investigations. AIT’s customers include the New York Attorney General’s Office, United States Attorney’s Office, the Criminal Division of the Internal Revenue Service, the United States Postal Inspection Service, Department of Securities, Securities and Exchange Commission, Federal Trade Commission, and other important state agencies, as well as the Miami Dade Police Department, United States Department of Agriculture, numerous commercial and international forensic accounting firms and many others. Founded in 1998 by Susan M. Deehan and Tim Deehan, AIT is dedicated to helping financial investigators make our country a safer place to live. AIT’s mission is to fight against financial crime by delivering the technology and expert knowledge to detect, investigate, and permanently dismantle the criminal organization. References available on request. For more information, visit http://aitcfis.com

1. National Health Care Anti-Fraud Association, “The Challenge of Health Care Fraud.” nhcaa.org/resources/health-care-anti-fraud-resources/the-challenge-of-health-care-fraud.aspx

2. Centers for Medicare & Medicaid Services, “National Health Expenditure Projections,” July 30, 2015. cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html

3. Cheung-Larivee, Karen, “5 states top Medicaid fraud list, States recover $1.7B,” Fierce Healthcare. fiercehealthcare.com/story/5-states-top-medicaid-fraud-list-states-recover-17b/2012-04-03

4. “By the numbers: fraud statistics,” Coalition Against Insurance Fraud.
insurancefraud.org/statistics.htm#.VjecX9KrSt9

5. “The Affordable Care Act and Fighting Fraud,” U.S. Department of Health & Human Services and U.S. Department of Justice. stopmedicarefraud.gov/aboutfraud/aca-fraud/index.html

6. United States Government Accountability Office, “Testimony before the Committee on the Budget, U.S. Senate,” gao.gov/assets/670/668828.pdf

7. U.S. Department of Health and Human Services, “Departments of Justice and Health and Human Services announce over $27.8 billion in returns from joint efforts to combat health care fraud,” hhs.gov/about/news/2015/03/19/departments-of-justice-and-health-and-human-services-announce-over-27-point-8-billion-in-returns-from-joint-efforts-to-combat-health-care-fraud.html

Karla Jo Helms, JoTo PR, +1 (888) 202-4614 Ext: 802, [email protected]

Modal title

Contact PRWeb

  • 11AM ET Sunday – 8PM ET Friday
  • Contact Us

About PRWeb

  • About PRWeb
  • Partners
  • Partnership Programs
  • Editorial Guidelines
  • Resources

Why PRWeb

  • Why PRWeb
  • How It Works
  • Who Uses It
  • Pricing

Accounts

  • Create a Free Account
  • Log in
  • Contact Us

Do not sell or share my personal information:

  • Submit via [email protected] 
  • Call Privacy toll-free: 877-297-8921

Contact Cision

Products

About

My Services
  • All News Releases
  • Online Member Center
  • ProfNet
Cision Distribution Helpline
888-776-0942
  • Legal
  • Site Map
  • RSS
  • Cookie Settings
Copyright © 2025 Cision US Inc.