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> Maybe it is because health-insurance billing is already so opaque and error-prone it provides cover for questionable services. At least in America, it seems
by ethbr0 5y ago
> Maybe it is because health-insurance billing is already so opaque and error-prone it provides cover for questionable services.
At least in America, it seems a consequence of the stratified, multi-party market.
Each participant only has limited visibility into the entire stack, which allows scams to appear more legitimate than they might in industries where each participant has a better view of the whole.
Also, as you say, it's just ridiculously manual for data entry. :-( But slowly getting better. But that means that the sort of heavyweight detection or correction algorithms one would use elsewhere would just spew nonstop false positives.
- refurb 5y agoMedicare (public healthcare for those over 65) has rampant fraud. So does Canada's single payer system.
- ethbr0 5y agoOn the Medicare side, rampant attempts, but also pretty constant auditing. It's a hard problem, but it does have a lot of people whose sole job it is to investigate it (on both the CMS and insurance provider sides).