Published: 2010-02-26 19:01:05
Author: LARRY MCCORMACK | THE TENNESSEAN | February 14, 2010
Emdeon Inc. processes nearly half of all commercial medical claims nationwide, giving the Nashville-based company a bird's-eye view of billing and other health-care trends.
It also has access to tons of information from providers, payers and others that can be used to more quickly spot fraud, waste and abuse, which reportedly eats up 10 percent of the more than $2 trillion in annual U.S. medical spending.
In the first chapter of a recent book titled Stop Paying the Crooks: Solutions to End the Fraud that Threatens Your Healthcare, Emdeon CEO George Lazenby dissected what he sees as key reasons it's so hard to recover missing money months after a fraud occurs.
He suggests a more proactive approach that uses technology and analytical tools to check claims for fraud on the front end before payments are made. Lazenby recently talked with Tennessean business writer Getahn Ward about health-care fraud, the reform efforts now stalled in Congress and Emdeon's evolving corporate strategy.
What's your core business and source of revenue?
Our core business right now is health-care transaction processing. We do roughly 5 billion transactions a year; 25 percent of those are medical claims. We do pharmacy, as well. We do electronic prescribing.
We do all sorts of things. For 700 payers nationally, we distribute explanations of benefits to their members. There are 1,200 payers in the country, and 700 of them use us.
The payer business is about 40 percent of our revenue; the provider business is 50 percent; and the pharmacy business is 10 percent. Within each of those business units, we have growth platforms.
How did you get involved with the book project, with Stop Paying the Crooks?
(Health-care analyst) Jim Frogue and (former Congressman) Newt Gingrich (both of whom are involved in a think tank on health policy) had decided they were going to pursue this topic because it's a big problem in health care.Full story