Reference no: EM133843870

Problem

The article goes over healthcare fraud in Texas. A supplier of durable medical equipment was found guilty of five counts of healthcare fraud due to false claims submitted to Medicare. The supplier was sentenced to 120 months of prison and $1.6 million in restitution.

What interests me, however, is further down the article where the author discusses how to combat fraud and abuse. One of those solutions was the implementation of computer-assisted coding (CAC). Computer-assisted coding is defined as "the use of computer software that automatically generates a set of medical codes for review, validation, and use based upon clinical documentation of the healthcare practitioner" (Rudman et al, 2006). They use natural language processing algorithms to automate the assignment of codes. This is supposed to help with fraud by driving healthcare reimbursement and compliance with anti-fraud and abuse regulations. Essentially, by utilizing software to create and audit trail, it will be easier to audit and detect coding errors and fraudulent practices over time. I found this very interesting after having recently done an assignment in a different class over auditing codes. If the government can have people in their own staff look over codes and determine if any set codes are fraudulent, then that will impact reimbursement for government services tremendously. It is not such great news for us coders because we are attempting to get into a field that is increasingly paving way for AI and computer programs to take over our jobs instead. This is why I want to transition to becoming a coding auditor one day so that I can retain job security despite upcoming changes to our industry. Get the instant assignment help.

1) What are some key take aways from the article?
2) Provide an open-ended question to your classmate regarding their article.