By NextBestFitTask 5.2.2 of 4
Prepayment review for high-risk categories (DME, hospice, lab, home health, behavioral-health outpatient), which have been Medicare's biggest fraud areas.
Who does it
UHA
When
Year 1+
Trade-off
Prepayment review targets high-risk categories but slows payments to honest providers.
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.