12 Apr Preventing FWA in Medicare and Medicaid with ALC Solution’s Technology Advantages
When adding a transportation benefit to your plan, it’s important to consider the potential consequences of fraud, waste, and abuse. Referred to as FWA in the healthcare industry, there are many different tactics and schemes that result in billions of monetary damage. Our innovative technology platform provides solutions to mitigate FWA for providers with transportation management benefits
What’s the Difference Between Healthcare Fraud, Waste, and Abuse?
The intent behind the action determines the difference between fraud, waste and abuse. When someone intentionally submits false information to the government or a government contractor to receive money or a benefit, that is fraud. Waste includes overusing services that directly or indirectly result in surplus cost to the Medicare Program. Abuse is defined as someone taking actions that do not align with accepted healthcare practices or fail to meet professionally recognized standards and produce an unnecessary cost. The financial consequences of abuse can be just as damaging as fraud. FWA can be demonstrated through this prescription example:
– Fraud is billing for non-existent prescriptions
– Waste is prescribing more medication than necessary for the treatment of a specific condition
– Abuse is billing for brand name drugs when a generic is dispensed
Mitigating Fraud, Waste, and Abuse on Medicare and Medicaid Accounts
With 18 years of Medicaid and Medicare enterprise account experience, ALC is constantly improving our technology platform to mitigate FWA. While our passenger-centric dispatch technology delivers safe and reliable transportation services, healthcare agencies appreciate our tailored daily, weekly, or monthly reporting. In addition to offering real-time updates and management support for your transportation benefit, ALC can also determine a schedule of services that meet budgetary requirements and trip quotas.
With more than 100 agents available at any given time, ALC’s reservations specialists confirm member eligibility, monitor locations for rides, track and the number of trips taken to ensure program benefits are not exceeded. A Medicare member may try to schedule a ride that evening to visit a friend or play bingo, but ALC’s technology ensures those requests don’t slip through the cracks. During the onboarding process with ALC, providers customize their desired customer experience, from the time required before scheduling a ride to creating an approved list of destination locations. Similarly, a Medicaid member may request a ride over to CVS with a false claim to pick a prescription, which can add up for millions in wasted spend. ALC is developing better optics to provide predictive intelligence for Medicaid members. Our team works with healthcare agencies to set customized parameters for members by state to mitigate abuse of transportation benefits.
ALC manages and monitors all modes of your members’ non-emergency transportation to provide cost-effective solutions and best-in-class service. Our network options include: mass-transit, mileage reimbursement, ambulatory curb-to-curb and door-to-door, wheelchair, gurney, bariatric gurney, and BLS. ALC not only improves the quality of service, but we also makes it easier for your members to utilize their transportation benefits.
If you have questions about adding transportation benefits to your plan, ALC can help. Connect with us for a free consultation about how we can save you costs, mitigate FWA, and improve efficiency.