Reports on Public Health Findings from Hefei University of Technology Provide New Insights (Research on the risk governance of fraudulent reimbursement of patient consultation fees): Health and Medicine – Public Health

2024 FEB 28 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Investigators discuss new findings in public health. According to news reporting out of Hefei, People’s Republic of China, by NewsRx editors, research stated, “BackgroundThe fundamental medical insurance fund, often referred to as the public’s ‘life-saving fund,’ plays a crucial role in both individual well-being and the pursuit of social justice. Medicare fraudulent claims reduce ‘life-saving money’ to ‘Tang’s monk meat’, undermining social justice and affecting social stability.”

The news correspondents obtained a quote from the research from Hefei University of Technology: “MethodsWe utilized crawler technology to gather textual data from 215 cases involving fraudulent health insurance claims. Simultaneously, statistical data spanning 2018 to 2021 was collected from the official websites of the China Medical Insurance Bureau and Anhui Medical Insurance Bureau. The collected data underwent comprehensive analysis through Excel, SPSS 26.0 and R4.2.1. Differential Auto-Regressive Moving Average Model (ARIMA (p, d, q)) was used to fit the fund safety forecast model, and test the predictive validity of the forecast model on the fund security data from July 2021 to October 2023 (the fund security data of Anhui Province from September 2021 to October 2023).ResultsThe outcomes revealed that fraudulent claims by health insurance stakeholders adversely impact the equity of health insurance funds. Furthermore, the risk management practices of Medicare fund administrators influence the publication of fraudulent claims cases. Notably, differences among Medicare stakeholders were observed in the prevalence of fraudulent claims. Additionally, effective governance of fraudulent claims risks was found to have a positive impact on the overall health of healthcare funds. Moreover, the predictive validity of the forecast model on the national and Anhui province’s fund security data was 92.86% and 100% respectively.”

According to the news reporters, the research concluded: “ConclusionWe propose four recommendations for the governance of health insurance fraudulent claims risk behaviors. These recommendations include strategies such as ‘combatting health insurance fraudulent claims to preserve the fairness of health insurance funds’, ‘introducing initiatives for fraud risk governance and strengthening awareness of the rule of law’, ‘focusing on designated medical institutions and establishing a robust long-term regulatory system’, and ‘adapting to contemporary needs while maintaining a focus on long-term regulation’.”

For more information on this research see: Research on the risk governance of fraudulent reimbursement of patient consultation fees. Frontiers in Public Health, 2024,12. (Frontiers in Public Health - http://journal.frontiersin.org/journal/public-health). The publisher for Frontiers in Public Health is Frontiers Media S.A.

A free version of this journal article is available at https://doi.org/10.3389/fpubh.2024.1339177.

Our news editors report that more information may be obtained by contacting Jiangjie Sun, School of Management, Hefei University of Technology, Hefei, People’s Republic of China. Additional authors for this research include Yue Wang, Yuqing Zhang, Limin Li, Hui Li, Tong Liu, Liping Zhang.

(Our reports deliver fact-based news of research and discoveries from around the world.)