While hard numbers can be difficult to pin down, experts agree that fraud in the healthcare field costs medical providers, insurance companies, and governmental agencies billions of dollars a year. The billions lost to fraud, waste, and abuse have a direct impact on the quality of patient care, diverting precious resources, driving up insurance rates and making health care more costly for everyone.
Over the years, efforts to root out this waste, fraud, and abuse have met with varying degrees of success. Some attempts have proven quite fruitful, while others went nowhere. And while there were some high-profile arrests, prosecutions, and imprisonments, no one is claiming that the days of healthcare fraud are now over.
Now, however, the days of rampant fraud, waste and abuse may finally be numbered. From insurance companies rooting out fraud and governmental agencies looking for ways to trim the fat to drug stores looking for unusual prescribing patterns, businesses and organizations of all stripes are using the power of the blockchain to find and punish the bad guys. Here are just three ways blockchain technology is helping the healthcare industry find and eliminate fraud.
1. Easy Detection of On-Chain Fraud Attempts
Healthcare fraud takes many forms, from medical clinics charging for operations that never took place to hospitals overcharging for those that do. Until now, these fraudulent and overpriced transactions have been hard to detect, but the blockchain is starting to change all that.
The inherent security, immutability, and transparency of the blockchain could make detecting fraud far easier, especially when combining those techniques with deep learning and other forms of artificial intelligence. In the future, a simple search of completed blocks could uncover fraudulent transactions that would otherwise have gone undetected.
2. Verification of Off-Chain File Integrity
Not all healthcare transactions take place on the blockchain, but even those offline transactions are not immune to fraud detection. Blockchain technology can also be used to verify the integrity of off-chain files, making fraud much harder to hide.
When doctors overcharge for the procedures they do or shady medical clinics make up fake patients, they often try to cover their tracks, altering files after the fact and taking other steps to hide the truth. By reviewing and verifying these files, blockchain technology could uncover these fraud attempts before payment is made, potentially saving healthcare providers, insurers, and the government billions of dollars.
3. Forced Transparency for Medical Providers
From the earliest days, the inherent transparency of the blockchain has been one of its main selling points. The ability to see every completed transaction has enormous benefits for both ordinary consumers and investors, and Bitcoin fans love to point out that the entire history of the cryptocurrency is right there on the blockchain.
That same level of transparency could be used to keep healthcare providers honest, forcing a degree of openness that had previously been impossible to implement. When they know that everything they do and every charge they submit is right there on the blockchain, doctors and the owners of medical clinics may be less likely to fudge the numbers or play fast and loose with the facts. This forced transparency could turn out to be one of the most effective fraud detection techniques the blockchain has to offer.
Only time will tell how blockchain technology will change the face of healthcare in the 21st century. Even so, this emerging technology is already making waves, and private healthcare companies, insurers, and governmental agencies are looking at how the blockchain could help them root out fraud, fight abuse and make the most of every dollar they spend on patient care.