Description: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.

Description: Actuaries should understand the economic considerations involved in the formulary drug decision-making process, and the presence of actuarial input in the process could improve it, especially by tying it to overall decision making for the health plan. From Prescription Drugs Monograph, M-HB04-1.

Description: This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment from providers who meet higher quality and cost-effectiveness standards.

Description: An economic analysis of bariatric surgery and health care costs supports the case for health plans to cover these procedures.

Description: Presenter discusses issues related to alternative care, as well as SOA activity in regard to alternative care. From the Record of the Society of Actuaries, Vol. 24, No. 1.

Description: Open meeting of the Society's Health Benefit Systems Practice Advancement Committee and Health Section Council, as well as the American Academy of Actuaries' Health Practice Council. The three committees review ongoing projects in the Health Practice area. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: A summary of Medicare reform and its effect on prescription drug coverage.

Description: Introduction to population health, a collaborative discipline that seeks to leverage all the determinants of health personal behaviors, medical care and the public health infrastructure, as well as the social and economic context at the community and national level to maximize the health of populations.

Description: In the course of consulting engagements, actuaries almost always find they need one or more of the following resources: -Healthcare data, which may be at the individual patient level or on a particular population. -Health services research studies which describe, summarize, try to alter, or predict patients’ use of health resources. -Health policy information, which describe public or private actions which affect the access, cost and quality of medical care. This document describes the ever-changing resources and specifies where they may be obtained.