Health care fraud, waste and abuse are inevitable in this country and seem to be growing. Andy Tolsma is a solutions manager for the P&C Medical Fraud payments accuracy division for Verisk Health. He believes that fraud is a very huge problem in the P&C industry that continues to grow even more. Andy estimates that, $234 billion goes to medical fraud, waste and abuse in the healthcare system annually – that’s $28.5 million an hour(Johnson, 2015). Medical fraud, abuse and waste can be identified. For example, when a provider bills for a 24 hours of work in a 5 or 6-hour day, this is seen as fraud. It can also be found in identity theft or when a provider is template billing- everyone seen is billed for the same procedures and diagnoses. Modifier
