By NextBestFitTask 5.2.1 of 4
Real-time predictive analytics on every claim (extending Medicare's Fraud Prevention System).
Who does it
UHA
When
Year 1+
Trade-off
Real-time analytics catch fraud early but can delay legitimate claims with false positives.
Part of: Run program integrity & fraud control
With one payer, fraud schemes that exploit gaps between payers disappear, but every scheme now targets one payer. UHP funds fraud control at a higher rate than Medicare does today.
This step changes 2 existing laws, programs, or institutions. See the list.