The healthcare industry, which accounted for 19.7% of gross domestic product in the United States, spent roughly $4.1 trillion in 2020 (cms.gov). According to the National Health Care Anti-Fraud Association (NHCAA), health insurance carriers suffer losses between 3% and 10% annually due to a number of reasons, including the overutilization of services, incorrect billing, and a lack of coordination of care (nhcaa.org). Care coordination works to prevent duplicate services and unnecessary services. Health insurance carriers, including managed care organizations and government sponsored-healthcare coverage plans, are continuously searching for ways to control healthcare costs and minimize losses.
Conduct research and write a 4-5-page paper on different strategies being used in healthcare today that assist in the prevention of fraud, abuse, and waste that also help control unnecessary spending. In your paper, be sure to address the following:
Describe different reimbursement options and how they work towards controlling cost.
Explain the concept of pay-for-performance.
Discuss how fraud, abuse, and waste impact the cost of healthcare.
Describe how the quality of the service rendered by healthcare providers impact their reimbursement.
Discuss why healthcare accounted for almost 20% of the U.S. gross domestic product in 2020.
Explain a recommendation for how you, as a healthcare consumer, can assist in the prevention of fraud, waste, and abuse.
Describe how managed care organizations incentivize healthcare providers.
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