In the Fight Against Fraud, Interoperability is a First Line of Defense

Dear Moxe Community,

In January, I shared that I thought 2025 was going to be a big year for healthcare interoperability. Judging from the response to CMS’s recent RFI on the health technology ecosystem, interoperability is having an even bigger moment than I anticipated. The enthusiastic response to the RFI suggests there is a demand for improving interoperability, and a lot of companies have solutions to drive it forward beyond philosophy to execution.

With the heightened focus on interoperability in healthcare, I agree with our founder Dan that it’s time to get very specific about the problems we are trying to solve so the best solutions can emerge. As we look ahead to the second half of 2025, I’m hopeful we can make measurable progress. Driving meaningful interoperability forward will take a village, and Moxe is committed to being a solution-focused leader in that space.

A big opportunity for interoperability

Moxe has been working on interoperability for more than a decade. In that time, we’ve seen the transformative power of connecting payers and providers with a precise, privacy-centric solution that releases only the minimum necessary data to requestors. Now, we’re seeing how interoperability can play a major role in combating fraud.

The FBI recently warned the public and healthcare sector organizations of phishing scams by fraudsters seeking to steal protected health information. The short story: Fraudsters have gotten really good at posing as CMS, and other requestors, and email and fax are their weapons of choice. One way to combat these fraudsters? Fully automated ROI.

When a health system leverages Moxe’s digital ROI solution, they’re fundamentally eliminating fraudulent payer requests. There’s no question that API-driven requests are coming directly from the approved payer or requestor.

While digital ROI won’t eliminate all fraud—there are cases of scammers posing as individuals — the vast majority of fraud cases are entities posing as payers. As our ROI partners see an increase in not only the number of payer requests, but also the number of fraudulent requests, digital ROI becomes essential to keep up with request volume, to ensure they are allocating resources to the requests that need a human touch, and to protect their patients’ data.

Where we go from here

Looking to the second half of 2025, our team is focused on a few key objectives:

1. Continuing to meet payers where they are in their consumption of clinical data. We’ll continue to provide more flexibility in the delivery of data, whether that means moving towards more streaming capabilities vs. call and response or newer formats that work better within their workflows. With feedback from our Payer Advisory Council and all of our payer customers, we’re working to support additional use cases to power the meaningful use of clinical data.
2. Expanding our network. We continue to work to connect to providers using the broad swath of EMRs in our current network and are aiming to effectively connect digitally to the long tail of EMRs. Electronic connection to clinical data is the future, and we’re working hard to expand our direct connection network quickly.
3. Supporting the government’s desire to push interoperability into the mainstream. Interoperability is having its moment. We’re going to continue to support driving meaningful interoperability in healthcare. Foundationally, that’s what Moxe is all about.

The clock is ticking on the second half of 2025. Let’s work together to ensure we can look back at the year six months from now and say it was one for the books when it comes to interoperability.

Sincerely,
Mike Coyne
CEO, Moxe Health