; investigative processes should be more intense -- similar to other types of crime- promote a more consistent approach to developing and prosecuting health care fraud cases Coordination Promote and foster communication:- increase communication between and among beneficiaries, advocacy groups, providers and government (state and federal)- engage providers to educate beneficiaries- contract with advocacy groups to educate beneficiaries- end Aturf battles@ among agencies- allow peer review organizations, carriers, and fiscal intermediaries to hold meetings without requiring HCFA approval Future Implications Future Challenges Expansion of preventative servicesHave a clear differentiation of all the terms -- fraud, waste, and abuse -- and we need different strategies to address each one. Our technology has to be able to differentiate between fraud, waste, and abuse. Law enforcement strategies also should be differentiated in addressing these three areas.Be aware of the extent that fraud and abuse efforts impact quality of patient careWork to stay abreast of the rapid changes in technologically based fraudIncrease partnering with providersFind consensus and buy in on the problems-- maybe use the Medicare Commission as a vehicle for discussionConnect fraud, waste, and abuse to quality issues, but will have to address the politics of thisWork to reduce the predictability of audit programs. Predictability makes it easy to Afly under our radar@Allow time to enhance our workforce -- need training and education and expectation that results may come laterDefine, prevent and detect fraud, waste, and abuse in managed careDevelop ways to objectively and quantitatively evaluate contractorsBuild trust with providers and beneficiariesAcquire and retain more and most appropriate resources (funds and personnel) to combat fraud and abuseResolve ALJ and appeals process issues Strategies Increase oversight of contractorsCoordinate data and use of systemsDecis...
