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Vulnerable Patient Populations are Being Treated by Fraudulent Health Care Providers

June 25, 2019

A new study dives into fraudulent health care providers and the patient population dynamics they are treating

The lead author of the study, Laura Nicholas, an assistant professor in the Department of Health Policy and Management at The Johns Hopkins Bloomberg School of Public Health, stated in an interview with FierceHealthcare, that the team entered the study with the expectation that “less savory healthcare providers” may be treating patients from vulnerable populations.

Studying the demographics of these 1.2 million Medicare patients, Laura and her team found that 28% of the patients were under the age of 65 and disabled while 45% of the patients were dually eligible for Medicaid. In a review of the patient’s ethnicity, many were nonwhite with about 16% of those treated being black, 10% being Asian, 5% being Hispanic, and 7% being from other ethnic or racial groups according to the study.

It was not surprising to find that these same fraud and abuse perpetrators are treating vulnerable populations at higher rates than other providers. They found that on average, 25% of patients who were dual-eligible for Medicare and Medicaid were treated by providers who were not engaged in fraud or abuse as opposed to 45% of patients who were dual-eligible for Medicare and Medicaid treated by fraudulent health care providers.

The study also looked at other factors such as specialty and location, to see if they impacted the trends. The researchers found that the trends held.

Nicholas and her team of researchers conducted the study and investigation from a “human interest” point of view due to the many tales of provider fraud and abuse in the headlines. Although they were disheartened to have their fears confirmed, they realized that the data suggests the problem is much larger when you look beyond one payer.

With more and more fraudulent provider stories surfacing, it is important for organizations to ensure transparency when hiring providers or contracting with entities to provide safe practices for patients.  “Because Verisys checks exclusion lists and thousands of primary sources, we are able to verify and monitor providers and entities finding what other compliance partners cannot,” says Valerie Mondelli, Verisys Chief Revenue Officer.  “We are able to supply the most accurate data to ensure organizations are protecting their patient populations.”

Organizations using Verisys for health care screening, verification, and monitoring, ensures they will achieve their goal of protecting patient populations while eliminating risk to their organization.


Heather Lynn Gillman Written by Heather Lynn Gillman
Director of Healthcare Communications
Problem Solver. Designer. Wine Maker. Writer.
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