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Risk Score Manipulation in Healthcare: How FreshCredit’s Scoring System can Lead the Change

In the healthcare industry, trust is paramount.

Unfortunately, this trust can sometimes be manipulated to the detriment of the very system it’s supposed to support. A case in point is the Medicare Advantage Plans, where member risk scores can be artificially inflated to extract more substantial payments from CMS (Centers for Medicare and Medicaid Services). Furthermore, there is an ongoing lack of vigilance, with CMS having failed to conduct audits for the last decade despite recognizing overpayments to the tune of $650M. These glaring issues point to the need for a reliable, transparent, and robust risk assessment model. FreshCredit, with its innovative scoring system, could be the solution to these ongoing challenges.

The Pitfalls of Current Risk Assessment Models

The current risk assessment models in healthcare leave much to be desired. They are not only subject to manipulation but also lack robust mechanisms to ensure checks and balances. Two major health insurance providers, Cigna and Elevance (Anthem), have been at the center of lawsuits alleging that they inflated members’ risk scores to receive higher payments from CMS.

However, the problem runs deeper than individual companies exploiting the system. CMS itself has been complacent, failing to perform audits in over a decade, despite identifying a staggering $650M in overpayments. This points to systemic issues in risk assessment models that call for an overhaul.

FreshCredit’s Scoring System: A Model of Transparency and Accuracy

In contrast to the opaque, easily manipulated risk assessment models currently in use, FreshCredit’s scoring system offers an innovative solution. Leveraging blockchain technology, FreshCredit creates a robust, transparent, and tamper-proof system. Its scoring model goes beyond just credit, incorporating asset and safety scores to provide a comprehensive view of an individual’s or entity’s financial health.

Blockchain: The Key to Revolutionizing Risk Assessment

FreshCredit’s utilization of blockchain technology is a game-changer for risk assessment. Blockchain’s inherent immutability ensures that once data is entered into the system, it cannot be altered or tampered with. This makes any attempt to overinflate scores easily detectable, ensuring the integrity of the system. Moreover, all transactions and modifications are recorded on the blockchain and can be audited in real-time, eliminating the need for expensive and time-consuming manual audits.

Trust and Accountability: The Potential Impact of FreshCredit

By addressing the shortcomings of traditional risk scoring systems, FreshCredit has the potential to restore trust and accountability in the healthcare industry. Manipulation of risk scores can lead to significant misallocation of resources, which can be largely avoided with FreshCredit’s scoring system. Healthcare providers would be able to represent their patients’ health conditions accurately, ensuring that CMS payments are fair and representative of actual needs.

FreshCredit’s Future: Towards a More Inclusive Financial System

FreshCredit’s innovative scoring system is a significant step towards a more inclusive and fair financial system. However, its potential impact goes beyond just providing a reliable, transparent, and tamper-proof scoring system. FreshCredit aims to drive financial inclusion, enabling individuals and businesses to make informed decisions based on accurate and comprehensive risk assessments.

As the systemic issues in traditional risk scoring become increasingly apparent, FreshCredit’s innovative system offers a shining beacon of hope. By harnessing the power of blockchain technology, FreshCredit stands ready to lead the charge in transforming risk assessment, not just in the healthcare industry but across multiple sectors.

FreshCredit’s Role in Reshaping Risk Assessment

The systemic issues plaguing healthcare risk scoring underline the urgent need for innovative systems like FreshCredit’s. By providing a transparent, tamper-proof, and easily auditable scoring system, FreshCredit has the potential to drastically reshape the landscape of risk assessment in healthcare and beyond. As we continue to innovate and expand our reach, we are committed to leading the transformation of risk assessment, empowering individuals, businesses, and healthcare providers alike.