​The United States spends much more per capita on healthcare than any other country.¹ And the cost of health insurance premiums, physician bills, pharmaceuticals, and medical tests, evaluations and treatments are on the rise. Insurance fraud, waste and abuse also play a key role in the rising healthcare expenses, costing individuals, businesses and the government billions of dollars a year.

The consequences of these rising costs are widespread and continue to grow each year. The increasing number of uninsured and underinsured families will eventually force the government to find the means to further expand and fund additional public healthcare programs, such as Medicaid and Medicare.

In February 2007, the Government Accountability Office (GAO) published a report (#GAO-07-497T) regarding healthcare spending. The report focuses on concerns regarding the federal government's ability to contribute to healthcare over the next few decades as the country’s demographic trends shift and healthcare costs continue to grow, as discussed in the following excerpt: 

"Over the next several decades, growth in spending on federal retirement and health entitlements will encumber an escalating share of the government's resources . . . In summary, projections show that the federal budget is on a path that is fiscally unsustainable, in large part because of growth in spending for Medicare and Medicaid." ²

Rising costs and abuse, combined with concerns surrounding patient confidentiality, places a great deal of pressure on the federal government to develop effective long-term solutions. To minimize the impact of cost and abuse on the industry and government, the federal government must ensure that policies and legislation are in place surrounding fraud protections and alerts, and also that regular review, investigation and audit practices are followed across all industries.

The movement toward interoperable electronic health records will create new challenges and opportunities with respect to protecting the privacy and security of patient health information. Although federal and state laws protect the confidentiality of healthcare information, these laws are inconsistent from state-to-state. Advances in technology also have created new concerns regarding the privacy of patient information and data.

Protiviti Related Solutions:

1. Business Operations Improvement
2. Enterprise Information Management
3. Litigation, Restructuring & Investigative Services
4. Anti-Fraud, Waste & Abuse Services
5. Enterprise Risk Assessment
6. Governance, Risk & Compliance Services
   - OMB A-123 - Internal Controls
   - OMB A-130 - FISMA
7. Identity & Access Management 
8. Information Assurance
9. Program/Project Management