Meet Joel Portice, recently appointed Chief Operating Officer of HealthCare Insight (HCI). Joel brings more than 18 years of experience in health care management claims software and analytics to HCI, as well as an extensive background in operational business development and systems integration.
Combining his efforts with HCI’s fraud detecting analytic software and a skilled team of licensed clinicians, Portice is quickly making strides to discover new methods of combating fraud, abuse and overpayment in the health care industry. Known for his fact-based decision making skills and ability to effectively connect with clients and colleagues alike, Portice is geared to make an impact and leave a lasting impression.
Profiler Magazine: What career steps lead you into medical fraud?
Joel Portice: While attending graduate school in Minnesota, I worked at Equifax Services and was introduced to health care fraud prevention. I found it highly interesting and undercapitalized in terms of companies investing in sophisticated and predictable solutions. I also saw a general lack of public awareness regarding the issue and an opportunity to add value to the inefficient health care industry. After completing graduate school, I co-founded a business that developed rules-based and data-driven detection services. Our emphasis was on the payor segment of the health care industry. After dabbling in claimant, disability and workers compensation fraud, we ultimately focused entirely on medical fraud as perpetrated by providers, resulting in rapid growth. The company was eventually acquired by a large health care payor.
PM: Serving as a legislative aide to United States Senator Tom Daschle introduced you to health care policy. With our nation currently debating health care reform, what changes would you like to see occur?
JP: The most pressing issue is to improve access and quality while reducing the economic burden health care has on American families. It is the number one cause of bankruptcy in our country today, and premium increases have regularly risen faster than the rate of inflation over the past several years. The World Health Organization consistently rates the quality of care below many other industrialized countries. We have great doctors and technology in this country, but the administrative burden and errors affecting our health care system are restricting the quality. With the continued shift of risk moving to providers and consumers, there will be greater demands on transparency and quality, requiring improvements in administrative efficiency.
PM: What area of health care needs the most attention in terms of preventing fraud and abuse?
JP: Payors still control 90 percent of the benefit payments in the industry and are critical to the handling of health care claims. They represent the largest constituency and can have the greatest influence on stopping fraud. Payor acceptance and implementation of sophisticated fraud-detection tools are required to address the problem. Public awareness and consumer participation are also necessary in the effort to reduce health care fraud.
PM: How can reducing fraud affect the entire health care system?
JP: The reduction of fraud will help ensure health care expenditures are appropriately allocated. Everyone talks about how expensive health care is. It is substantial and will soon consume 20 percent of the U.S. Gross Domestic Product, but no one knows what it should cost for our society. Reducing fraud, waste and abuse promotes suitable spending practices that will have a positive impact on our ability to care for the sick and injured.
PM: What advice can you give consumers to guard against fraud and medical ID theft?
JP: Review billing statements and EOBs. Ask questions of providers before services are provided to ensure it is medically necessary. If a discrepancy is identified, be sure to notify the claims administrator.
PM: What goals would you like to see HCI achieve in the coming years?
JP: I would like to see HCI continue to maintain significant growth in terms of revenue and profitability, refine business practices, and further demonstrate the industry’s most reliable and sophisticated anti-fraud solution. We must also recognize the benefits of strong, positive relationships with our customers and partners, and maintain a culture in which employees are proud to be accountable for their performance and experience professional advancement.
