E-records may end fraud.

• Author: Swartz, Nikki
• Position: UP FRONT: News, Trends & Analysis

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Only a small percentage of the estimated 4 billion healthcare claims submitted annually in the United States are fraudulent, but the total cost of fraudulent or improper claims is substantial.

The National Healthcare Anti-Fraud Association estimates that in 2003 alone, at least 3 percent--$51 billion--of the nation's healthcare expenditures were lost to outright fraud. Other estimates by government and law enforcement agencies place the loss as high as 10 percent of annual expenditures, or $170 billion each year.

The Foundation of Research and Education of the American Health Information Management Association recently issued two reports detailing how health information technology can address the growing problem of healthcare fraud.

The reports are the result of a six-month project commissioned by the Office of the National Coordinator for Health Information Technology within the Department of Health and Human Services (HHS) that involved two main tasks: 1) a descriptive study of the issues and steps in the development and use of automated coding software that enhance healthcare anti-fraud activities; and 2) identifying best practices to enhance the capabilities of a nationwide interoperable health information technology infrastructure to assist in prevention, detection, and prosecution in cases of healthcare fraud or improper claims and billing.

"These reports show that information technology can change the way we think about preventing fraud and abuse," said National Health Information Technology Coordinator David J. Brailer. "Information technology can give us new tools to reduce healthcare fraud losses."

According to the Centers for Medicare and Medicaid, fraud may take different forms, such as...