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SKYGEN USA

Five Technology-Aided Best Practices for Identifying Fraud & Abuse in Pediatric Medicaid Dentistry

SKYGENUSA Powering Healthcare for the Digital Age

Wasteful spending on healthcare in the United States totals hundreds of millions of dollars each year. While the country spends more than $2 trillion on healthcare annually, it is estimated that at least 3%, or $68 billion, is lost to fraud. Many of the victims are those in greatest need - America’s children supported through Medicaid programs.

Mr. Craig Kasten, CEO and Managing Partner of SKYGEN USA, highlights compelling advances the industry must take to detect and address fraudulent activity as a fundamental strategy to reduce healthcare costs and manage the health of those most vulnerable. State-of-the-art administration technology designed to implement provider profiling coupled with premier benefit management services will become the primary course of action for payers to achieve greater value and effectiveness for every healthcare dollar spent.

Mr. Kasten outlines five technology-aided best practices to reduce the potential of fraud and abuse in pediatric dental care:

  1. Data analysis to identify potential fraud and abuse
  2. The aggressive investigation of suspected abuse or abuse cases
  3. The implementation of payment constraints
  4. Family education
  5. Collaboration between payers and providers with dental schools

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