AHIMA FOUNDATION TO STUDY USE OF HEALTH INFORMATION TECHNOLOGY TO ADDRESS HEALTHCARE FRAUD
National Coordinator Funds Research on Capabilities of HIT to Prevent and Detect Anti-fraud Activities

CHICAGO, April 28—A new study to be conducted by the Foundation of Research and Education (FORE) of the American Health Information Management Association (AHIMA)—under contract to the Office of the National Coordinator for Healthcare Information Technology (ONCHIT)—will look at how automated coding software and a nationwide interoperable health information technology infrastructure can address healthcare fraud issues.

”The purpose of this project is to explore how the use of health information technology can enhance and expand healthcare anti-fraud activities,” says David J. Brailer, MD PhD, National Coordinator for Health Information Technology. “As the healthcare sector embraces electronic health records to reduce medical errors and improve cost-effective delivery of care, these same technologies have the potential to prevent and detect health care fraud.”

While only a small percentage of the estimated 4 billion healthcare claims submitted each year are fraudulent, the total dollar amount of these claims can add up. According to the National Health Care Anti-Fraud Association (NHCAA), estimates of the country’s losses to healthcare fraud range from 3 to 10 percent of U.S. health expenditures each year, or an estimated $56.7 billion to $170 billion annually.

“While other sectors of the economy, such as the credit card industry, have harnessed the power of technology to prevent, detect and reduce fraud, fraud prevention and detection solutions are relatively new to healthcare,” says Linda Kloss, RHIA, CAE, AHIMA’s CEO. “Fraud can be detected and reduced by a variety of information technology capabilities including abnormal pattern recognition, powerful system audits and practice pattern monitoring."

Under the terms of the contract, FORE will focus on two main tasks. Task One is a descriptive study of the issues and the steps in the development and use of automated coding software that will enhance healthcare anti-fraud activities. Task Two will identify best practices to enhance the capabilities of a nationwide interoperable health information technology infrastructure to assist in healthcare fraud prevention, detection and prosecution. An expert cross-industry committee composed of senior level executives from both the private and public sectors will guide this second task. The field research methodology will utilize these cross-industry experts as well as literature review, structured survey process and data collection, and site visits and interviews.

The final report on the combined tasks is scheduled to be completed in September 2005.

AHIMA is the premier association of health information management (HIM) professionals. AHIMA's 52,000 members are dedicated to the effective management of personal health information needed to deliver quality healthcare to the public. Founded in 1928 to improve the quality of medical records, AHIMA is committed to advancing the HIM profession in an increasingly electronic and global environment through leadership in advocacy, education, certification, and lifelong learning. For information about the Association, go to www.ahima.org.

FORE provides financial and intellectual resources to sustain and recognize continuous innovation and advances in HIM for the betterment of the profession, healthcare, and the public. For more information about FORE, go to http://www.ahima.org/fore/.

The mission of ONCHIT is to implement the President's vision for widespread adoption of interoperable electronic health records (EHRs) within 10 years. Appointed in May 2004, Dr. David Brailer, M.D., Ph.D., National Coordinator of Health Information Technology, serves as the senior advisor to the Secretary of Health & Human Services and the President of the United States on all health information technology programs and initiatives. Dr. Brailer’s office develops and maintains strategic plans to guide the nationwide implementation of interoperable EHRs in both the public and private healthcare sectors, helps coordinates health information technology programs and initiatives across the federal enterprise, coordinates all outreach activities to the private industry, and serves as the catalyst for healthcare industry change. For more information about ONCHIT, go to http://www.os.dhhs.gov/healthit/.