The AHA today responded to a Centers for Medicare & Medicaid Services request for information on its Comprehensive Regulations to Uncover Suspicious Healthcare, or CRUSH, initiative. The RFI seeks stakeholder feedback on potential regulatory changes that might be included in a potential future CRUSH proposed rule, as well as other programmatic changes that could be implemented to combat fraud, waste and abuse in federal health care programs. The AHA urged CMS to ensure that any such changes are appropriately data-driven and do not add unnecessary administrative burden for hospitals. The AHA encouraged CMS to increase federal oversight and scrutiny of certain Medicare Advantage Organization coverage and reimbursement practices. Additionally, the AHA recommended that CMS leverage and strengthen its existing oversight tools, processes and transparency requirements in Medicaid and the…
Identity theft is the “foundational” fraud upon which many other crimes are built. It involves the unauthorized acquisition and use of a person’s personal identifying information (PII), such as an ID number, Social Security number, or passport details.
- How it works: Fraudsters obtain PII through data breaches, mail theft, or “social engineering” (tricking people into revealing details). Once they have this data, they can open new bank accounts, apply for credit cards or loans, and even receive medical treatment under your name.
- Synthetic Identity Fraud: A sophisticated variation where criminals combine real and fabricated information to create a completely new, “synthetic” person. This is particularly difficult to detect because there is no single victim to report the suspicious activity initially.