Insurance
exchanges have now been approved by the Obama administration for 17
states. The exchanges will operate as an
open marketplace for individuals and small businesses that will be able to log
in to an insurance portal to purchase their preferred insurance product. Open enrollment will begin in October and by
January, people and businesses will be able purchase insurance products through
the exchanges with assistance from Federal subsidies.
As
the implementation of exchanges begins, all eyes will be looking toward fraud
detection and avoidance. The health care
IT industry will have a massive task ahead of them as these exchanges become
live. Data mining and data detection
will become key components in the fight against fraud within the exchange
models. Experts assert that feedback and
data pattern detection technology will play a large role in this process. The fraud detection systems will need to be
incredibly nimble as well, due to the large numbers of transactions that will
occur daily through the exchanges. There
will be a sharp learning curve in this sector of the IT industry and the
ability to be nimble and reactive will be important.
Planning
for this undertaking can only be done partly, as there are many unknowns and
live data will be needed to ascertain the fraud opportunities and problems that
may arise. There are parallel industries
that can help the exchanges prepare, such as existing health insurance IT
models and disability insurance programs where fraud is commonly sought and
detected.
As
health insurance exchanges move forward, the perpetrators of fraud will surely
continue their efforts. It remains to be
seen how effectively the industry will be able to combat fraud in health
insurance, and how much this prevention and detection will ultimately cost the
industry and taxpayers.
