Healthcare spending in the United States represents over $2.5 trillion or approximately 17% of GDP. Private market spending growth in excess of 6% annually and government rates in excess of 7% annually are driving growth in the industry which is expected to exceed $4.5 trillion or approximately 20% of GDP by the end of this decade. This unparalleled industry dynamic has been shadowed by and equally extraordinary growth in the incidents and scale of fraud and abuse within the healthcare payments system. Healthcare fraud and abuse accounts for approximately $200 billion of healthcare spending annually. Significant investments in fraud and abuse prevention have been rare in the industry for much of its history. However, such initiatives have recently received wider private and government market acceptance.
Investments in fraud prevention and recovery have seen rates of return on invested capital of 10x to 15x. These impressive rates of return on capital in the sector appear even more remarkable when one considers the primitive strategies used by the market to fight fraud and abuse. The sector has adopted what is called a “pay and chase” model to fight fraud and abuse. In practice, government and commercial payers today, when faced with fraudulent claims, pay illegitimate providers and then seek to recover damages after the fact. Recoveries are then only received after an investment of money, time and other limited resources is made.
The Department of Recovery and Prevention “DOR” is the industry’s first and only provider of integrated investigatory services and healthcare data aggregation and analytics. The DOR is uniquely positioned to provide its own primary investigatory research as well as onsite inspection data. Beau Dietl & Associates created the DOR’s certification process. It is a three phase process that functions as a failsafe mechanism to prevent fraud and abuse prior to its occurrence. This is the only mechanism that enables us to prevent fraud before it occurs. Every step of the process is carried out and overseen by one of our thousands of experienced nationwide investigators collected in our network database.
The first phase entails a corporate entity certification and site survey. This provides a comprehensive background investigation on the entity as well as its owners, management and even its investors. The second phase entails a comprehensive background check on key personnel and staff, including doctors, nurses and physician assistants.
The DOR has a continuous monitoring system which will catch all fraudulent activity. This is addressed in our third phase through overt and covert field investigations. Overt investigations may include interviews with patients, staff or doctors. Covert investigations are handled in a similar manner; however, the DOR employs an undercover operative to ascertain the condition of the business.
All investigators are equipped with state of the art technology that enables all material to be synced in real-time which is unprecedented in today’s market. The DOR and its personnel works efficiently while maximizing results.
DOR will undergo a buyout of a leading healthcare services company and combine it with the finest investigators and healthcare industry professionals in the nation to become the industry’s first and only holistic fraud prevention and recovery business. The combination of its team of investigators and its proprietary technology make DOR the industry’s only early?warning solution for fraud and abuse.