Loss Calculation

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By Jaysen Eisengrein
I attended two really great sessions at today’s HCCA Managed Care Compliance Conference in Las Vegas. One session was regarding fraud and abuse in managed care and the other was about coordinating with the litany of government oversight and investigative agencies.

While these are tricycle areas to navigate in the world of compliance, effective navigation is needed as managed care approaches 75% or more of the Medicaid population and the large share of Part C subscribers. One particularly tricky area is in identifying AND, almost more importantly, quantifying the dollar “loss” or amount attributable to the aberrant behavior. I heartily recommend seeking services from skilled fraud and abuse professionals that have experience in working these issues from a government perspective.

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