Briana Contreras, an editor with Managed Healthcare Executive, had a chat with Clay Wilemon, CEO of 4L Data Intelligence, in this month’s episode of Tuning In to the C-Suite. The discussion was on the subject of fraud, waste, and abuse within the healthcare industry and how much of it stems from issues like overpayment. Clay addressed how the adoption of artificial intelligence can help combat fraud, waste and abuse and shared how much the industry can save by using AI.
Contreras and Wilemon's discussion was on the subject of fraud, waste, and abuse within the healthcare industry and how much of it stems from issues like overpayment. Clay addressed how the adoption of artificial intelligence can help combat fraud, waste and abuse and shared how much the industry can save by using AI.
"You know, as a system, we are overpaying for healthcare in many cases, and that shows up as fraudulent activity, wasteful or abusive billing," Wilemon said in the conversation. "Why is it an issue now? Healthcare is a $4 trillion market in the United States. It's a lot of money. It's the biggest segment of our economy, and we're all dependent upon it. Costs just keep escalating."
It's estimated that fraud, waste and abuse is somewhere between the low end $250 billion a year and on the high-end estimates as much as $800 billion.
Wilemon added if we can eliminate that overpayment dynamic, then that makes healthcare more accessible and it reduces the cost to companies, to taxpayers, and to individuals who are seeking healthcare.
2023 Drug Trend Report - Xevant
May 16th 2024To effectively navigate the changing pharmacy landscape and maintain a robust, cost-effective pharmacy benefit, you must understand the forces behind rising drug trend. What’s driving your costs and what can you do about it? As a leader in the PBM analytics space, we offer a unique perspective on pivotal trend drivers. Here’s what our comprehensive analysis revealed: -A surge in utilization rates across specialty and non-specialty drugs, magnified by anti-obesity therapies -Financial strain imposed by anti-inflammatory biologics and the yet-to-be-fulfilled -promise of biosimilar savings -Persistent price inflation driving higher costs year over year
Read More
2024 Emerging Leaders in Healthcare — Submit For a Chance to Be Featured in MHE's August Issue
May 14th 2024MHE Editors are seeking diverse healthcare professionals from different backgrounds and healthcare sectors, with individual interests. Eligible candidates are early or mid-career leaders with less than 10 years of experience. Award winners will enjoy complimentary passes to the PBMI Annual National Meeting in Orlando, Florida, from Sept. 4-6. Additional perks include a feature in our August issue, a subscription to MHE and more!
Read More