Business Cases| HEALTH CARE DOCUMENTS PROTECTION | Business Case 3 |
| Category | B2C, B2B | | The Challenge | Health care insurance fraud is one of the most serious and growing crime phenomena. Government and private insurers lose hundreds of millions of dollars annually to criminal rings making fraudulent claims using falsified documents. According to the National Health Care Anti-Fraud Association (NHCAA) $39 billion of annual health care outlay in the U.S. is lost to outright fraud. In May 2002, NHCAA reported that insurers collectively recovered or prevented payment of just under $356 million for 2001 as a direct result of their anti-fraud activities - however 90% of losses are not recovered with existing anti-fraud initiatives.
Most fraud cases make use of falsified or modified claim documents that are used as a crucial part in the evidence process. Protection of such documents against forgery is currently entirely insufficient. | | Environment | Health insurances, health services, social security, hospitals, physicians and other health care professionals, fraud investigation | | The Solution | Protection, integrity and authenticity of medical documents are crucial in order to halt insurance claims forgery. The healthcare and insurance industries can now monitor and inspect all claims cases that induce doubt or uncertainty. Physicians, hospital workers or anyone in the health care process chain cannot modify or question any document protected by PDMark solution. | | Description | It is essential for health insurance companies to have genuine and authentic documents, as these form the basis on which they have fullfil their obligation to deliver significant financial compensation. - Insurance companies can utilise PDMark client application in their contractual hospitals.
(Only standard office equipment is required). - The application itself will not hinder medical personnel as it works in tandem with the standard medical system.
Personnel do not need to push even one button more than usual. - Every created document will have its own protection which remains with it. In addition to document data,
it will also include all relevant information about the author, time and date of creation etc, - The document can be checked and imported electronically into the system of the insurance or investigation
office using standard office equipment
| | Benefits | - Impossible to forge or modify documents after creation, preventing fraud attempts.
- Indubitable chain of evidence in healthcare cases, saves finances for insurance companies.
- Establishes trust and confidence of health care document process between various stakeholders
(insurance, patients, hospitals, pharmacies, laboratories etc.)
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