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NHCAA Fraud Solutions Index
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The National Health Care Anti-Fraud Association would like to acknowledge our 2010 Premier Supporting Members & Supporting Member for their outstanding commitment to the fight against health care fraud.
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NHCAA 2010 PREMIER SUPPORTING MEMBERS |
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CGI Federal Inc.
1001 Lakeside Avenue
Ste 800
Cleveland, Ohio 44114-1151
Phone: 720.261.4416
Website: www.cgi.com/healthcare
Email:HealthIT@cgi.com
CGI unites advanced technology with healthcare, government, workers compensation and P&C fraud expertise to bring exceptional fraud, waste and abuse identification, prevention and resolution to payers of medical and pharmacy claims.
Specifically, CGI’s Customized Audit System (CAS 5.0) identifies fraud, waste and abuse based on clinical and operational algorithms and system edits for medical and pharmacy claims. Our Special Investigative Services Division provides investigative support, training and compliance services. CAS 5.0 is available as a licensed or SIU co-sourced option. |
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EDIWatch, Inc. 
322 Maxwell Rd
Ste 300
Alpharetta, GA 30004-1991
Phone: 770.740.6300
Website: www.ediwatch.com
Email: info@ediwatch.com
EDIWatch, Inc. is the premier provider of anti-fraud solutions to the healthcare industry. Our breakthrough suite of innovative products and services address all three anti-fraud objectives: Detection, Recovery, and Prevention, and are being implemented in Medical Affairs and Provider Relations departments to improve productivity, efficiency, and maximize bottom-line savings. www.ediwatch.com |
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Emdeon
 3055 Lebanon Pike
Nashville, TN 37214
Phone: 615.932.3000
Website: www.emdeon.com
Email: moreinfo@emdeon.com
Emdeon is a proven provider of claims, payment and fraud and abuse management solutions that streamline processes and lower overall healthcare costs. Our Payment Integrity Services help payers identify, process and pay only valid healthcare claims, reducing lost healthcare dollars. Emdeon’s depth of data and peerless connectivity enable flexible fraud solutions payers can implement at any point in the claims process, adapting with the business as it grows. Emdeon can help you be confident that when you pay a claim, it’s a payment worth making. Learn more at www.Emdeon.com/paymentintegrity. |
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Etico, LLC
 6775 West Washington Street
Milwaukee, WI 53214
Phone: 414.828.6884
Website: www.etico.com
Email: info@etico.com
Etico, LLC
A new name in the health care fraud and abuse landscape, but a company with deep roots in the nation's fight against health care fraud. Etico provides our clients with customized fraud control solutions—combining intelligent tools and expert analysis with knowledgeable counsel from industry experts. Etico’s team brings vast expertise and decades of private and public sector experience to bear in helping clients control health care costs by effectively reducing, recovering and preventing losses to fraud and abuse.
Our Services
Consulting services to identify and manage fraud and abuse risks, benchmark and increase anti-fraud effectiveness/results and meet applicable regulatory compliance obligations.
Fraud and Abuse Control services, from specialized functions to supplement or aid existing anti-fraud operations to full-spectrum anti-fraud functions and capabilities, including investigative and forensic medical review services.
Law Enforcement Support, from case-specific or broad-based data analysis and presentation to specialized medical review, training and expert testimony in support of investigations and prosecutions.
Our Clients
Etico serves health insurers and managed care organizations; property/casualty medical-claim payers; third-party administrators; self-insured and self-administered health plans; state and certain federal health plans; and state/federal/local law enforcement agencies.
Partners in Health Care Fraud & Abuse Solutions: www.etico.com |
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FICO
901 Marquette Ave., Ste 3200
Minneapolis, MN 55402
Phone: 888.342.6336
Website: www.fico.com
Email: info@fico.com
FICO™ (NYSE:FIC) is the leader in Decision Management, transforming business by making every decision count. We use predictive analytics to help businesses automate, improve and connect decisions across organizational silos and customer lifecycles. FICO's Insurance Fraud Manager Healthcare edition is tailored specifically to meet the needs of Healthcare Payers, with predictive analytic models that help detect and prevent more fraud than rules only bases systems. The FICO solution includes complete investigative case management functionality with best practices for specific types of cases, and tools for managing the tasks and workflows needed for claim level and broader provider investigations. To learn more how FICO can bring you the advanced power of predictive analytics, click here. |
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HealthCare Insight, Inc. 
10897 S. River Front Pkwy
Ste 200
South Jordan, UT 84095
Phone: 877.619.5557
Website: www.hcinsight.com
Email: info@hcinsight.com
HealthCare Insight (HCI) provides health care payors with a comprehensive suite of clinically validated fraud, abuse and overpayment prevention services designed to maximize payment accuracy and reduce costs. Each of HCI’s customizable SaaS solutions relies on a unique prepayment process that combines proprietary software with review by experienced clinicians. For more information visit www.hcinsight.com or call 1.877.619.5557. |
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HMS
401 Park Avenue South
New York, NY 10016
Phone: 877.467.0184
Website: www.hms.com
Email: info@hms.com HMS is the nation's leader in cost containment, coordination of benefits and program integrity services for government healthcare programs. The company's clients include health and human services programs in more that 40 states, 80 Medicaid managed care plans, the Centers for Medicare and Medicaid Services (CMS), and Veterans Administration facilities. Every year, HMS recovers more than $1 billion from third parties and other funding sources for its clients, and provides data that assists them in saving billions of dollars more. HMS is a wholly owned subsidiary of HMS Holdings Corp. (NASDAQ: HMSY), which is headquartered in New York and operates offices nationwide.
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IBM
150 Kettletown Road, MD#223
Southbury, CT 06488
Phone: 866.757.1105
Website: www.ibm.com
Email mandy@us.ibm.com
IBM’s Business Analytics and Optimization solutions provide healthcare organizations with the ability to quickly identify fraud, waste, and abuse within healthcare claims data. The IBM Fraud and Abuse Management System (FAMS) increases investigator productivity and identifies the most egregious offenders. FAMS assists organizations with; detection, investigation, settlement and prevention. |
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Ingenix 
12125 Technology Dr
Eden Prairie, MN 55344-7312
Phone: 888.445.8745
Website: www.ingenix.com
Email: info@ingenix.com
Ingenix delivers Intelligence for Health Care. A UnitedHealth Group (NYSE: UNH) company, Ingenix unites the brightest minds to transform organizations into market leaders and improve health care through information and technology. Ingenix serves a diverse customer base within the health care community. For more information about Ingenix and its products and services, please visit www.ingenix.com. |
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IntegriGuard, LLC 
2121 N. 117 Avenue, Ste 200
Omaha, NE 68164
Phone: 402.498.2400
Web site: www.integriguard.org
Email: hqinfo@integriguard.org
IntegriGuard is an ISO-certified and URAC-accredited organization devoted to the prevention and detection of fraud, waste, and abuse in federal healthcare systems. IntegriGuard offers a suite of program integrity and payment accuracy solutions designed to detect fraud and improper payments. The company’s services include audit, compliance & education, data & analysis, eligibility verification medical review, and investigation. In addition to being designated by the Centers for Medicare & Medicaid Services (CMS) as one of 12 Program Safeguard Contractors, and one of eight Medicare Prescription Drug Integrity Contractors, IntegriGuard is one of eight Qualified Independent Contractors for CMS. IntegriGuard is a wholly owned subsidiary of HMS Holdings Corp. (NASDAQ: HMSY), which is headquartered in New York and operates offices nationwide. |
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LexisNexis 
1000 Alderman Drive
Alpharetta, GA
Phone: 1.866.242.1442
Website: http://www.lexisnexis.com/risk
Email: www.lexisnexis.com/risk/contact
LexisNexis is a leading global provider of content-enabled workflow solutions designed specifically for professionals in the legal, risk management, corporate, government, law enforcement, accounting, and academic markets. LexisNexis originally pioneered online information with its Lexis and Nexis services. A member of Reed Elsevier, LexisNexis serves customers in more than 100 countries with more than 18,000 employees worldwide.
LexisNexis is the leader in providing essential information that helps advance industry and society. Building on the legacy of proven LexisNexis services from the past 30 years, our cutting-edge technology, unique data and advanced scoring analytics provide total solutions that address evolving client needs in the risk sector while upholding high standards of security and privacy. LexisNexis Risk Solutions serves commercial organizations and government agencies and is comprised of several affiliated corporations, each offering premier customer-focused solutions. For more information, visit www.lexisnexis.com/risk.
LexisNexis Healthcare Solutions helps companies:
Determine patient identity
Predict payment
Improve collections results
Reduce fraud, waste and abuse within the claims process
LexisNexis offers a full suite of solutions for payers, providers, and intermediaries to help them make informed decisions. |
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McKesson Health Solutions
5 Country View Road
Malvern, PA 19355
Phone: 800.782.1334
Website: www.mckesson.com
Email: mhs@mckesson.com
InvestiClaim™ is McKesson’s new web-based, fraud and abuse detection and management solution. Industry leaders McKesson and Fair Isaac Corporation have partnered to deliver this innovative product combining McKesson’s extensive claims management and clinical expertise with Fair Isaac’s predictive analytics and decision-making technology. InvestiClaim automates the detection of fraud and abuse. It alerts users to aberrances and trends in claims data, highlighting the most probable cases, significantly reducing “false positive” leads, and saving resources for critical investigations. |
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SAS 
100 Campus Dr
Cary, NC 27513
Phone: 919.677.8000
Website: www.sas.com
SAS is the market leader in providing a new generation of business intelligence software and services that create true enterprise intelligence. SAS solutions are used at more than 40,000 sites - including 90 percent of the Fortune 500. In healthcare, SAS solutions are used in half of the Top 100 Hospitals (per Solucient research as reported in Modern Healthcare) and 100 percent of the top 25 health plans - to improve quality of care, productivity, member/staff relations; to enable better and more informed decisions; and to drive organizations forward. SAS Fraud Detection and Prevention for Health Insurance draws on the power of SAS' advanced predictive modeling techniques built on a foundation of award-winning data warehousing and data mining technology. The SAS solution goes beyond typical fraud detection solutions by offering advanced analytics that enable predictive, accurate claims decisions before those claims are paid. For nearly three decades, SAS has been giving customers around the world The Power to Know(r). To find out more about how SAS can help your organization reach its full potential, visit us at www.sas.com. |
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TC³ Health, Inc. 
19732 MacArthur Blvd.
Suite 100
Irvine, CA 92612
Phone: 714.689.1900
Website:www.tc3health.com
Email: info@tc3health.com
TC³’s integrated loss control model, the TC³ Funnel, enables payers to sequence multiple prepayment loss control technologies through a single connectivity source, assuring payment integrity while reducing paid medical exposure by 5-10% annually. The TC³ Funnel includes the following integrated components: Prepayment TIN Driven and Analytic Fraud Detection with investigations, OFAC Compliance, Clinical Coding Compliance, AccessPlus Supplemental PPO Program, Cost-to-Charge Benchmarking and Negotiations, Web-Enabled Reporting, Predictive and Plan Modeling. For more information visit www.tc3health.com |
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Thomson Reuters 
777 Eisenhower Parkway
Ann Arbor, MI 48108
Phone: 734.913.3000
Website: www.thomsonreuters.com/healthcare
Email: FedGov@thomsonreuters.com
Thomson Reuters is dedicated to fighting fraud, waste, and abuse in the U.S. healthcare system. As the world's leading source of intelligent information for businesses and professionals, Thomson Reuters combines industry expertise with innovative technology to deliver critical information to leading decision makers in the financial, legal, tax and accounting, healthcare and science, and media markets, powered by the world's most trusted news organization. With broad and deep fraud-fighting experience, Thomson Reuters brings to your organization a high level of expertise and a proven record of delivering results. |
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ViPS, Inc. 
One West Pennsylvania Ave
Ste 700
Baltimore, MD 21204
Phone: 410.832.8300
Website: www.vips.com
Email: info@vips.com
ViPS®, a General Dynamics Information Technology Company, is a leading provider of healthcare information technology and informatics solutions that help government and commercial health plans improve patient outcomes, enhance market position and reduce costs. Located in the Baltimore-Washington, DC area, ViPS has specialized exclusively in healthcare since 1979. The company’s healthcare and data management expertise, premier technologies, multiple platforms and best-of-breed components cover a broad range of solutions from advanced data warehousing and data management... to fraud, waste and abuse prevention... to quality and efficiency measurement for clinical improvement and much more. ViPS provides solid results, offering a proven track record, unparalleled customer service, and a quality-driven focus that support efficient, consumer-directed, real-time enterprises. www.vips.com.
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NHCAA 2010
SUPPORTING MEMBERS |
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ACS, A Xerox Company
 900 Packer Avenue
Suite 101
Philadelphia, PA 17148
Phone: 484.213.6939
Website: http://www.acs-inc.com/
Email: Lynn.Poulos@acs-inc.com
ACS offers an unparalleled suite of auditing solutions that ensure compliance with state and federal guidelines; identify and recover overpayments; detect and stop fraudulent activities; and educate providers to prevent future problems — ensuring that private and public health plan dollars are spent appropriately on patient care.
The combination of innovative technology, seasoned auditing professionals, local and national experience, and extensive knowledge of healthcare systems and services position ACS as a leader in auditing for fraud, waste and abuse within the provider network.
Our areas of specialization include:
On Site Audits
Desk Audits
Home Infusion Therapy Audits
Durable Medical Equipment Audits
PBM/Plan Audits
Rx Claims Check
Specialty/Injectable
Mail Order Review
Analytics and Reporting
Product/Verification
Compounding
Member Lock-in
Physician Profiling
Credentialing Programs |
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Digital Harbor Inc.
(Norkom Tchnologies) 
1851 Alexander Bell Drive
Reston, VA 20191
Phone: 703.476.7345
Website: www.dharbor.com
Email: info@dharbor.com
Digital Harbor, a Norkom Technologies affiliate offers Industry’s most advanced end-to-end Operational Intelligence Suite for detection, investigation, assessment and monitoring. Proven in some of the largest US Financial Institutions and Government Intelligence Agencies, our award winning Application Platforms deliver Real-time Analytics, Enterprise Case Management and Dynamic Dashboard technologies for Proactive Fraud & Risk Management. Our innovative technologies range from predictive-based detection of complex fraud associated with False Store Front Providers and Organized Crime to behavior-based identification of fraud in DME, Home Health and Managed Care services. Our innovative Solutions include Automated Enrollment Due Diligence (Know Your Provider), Proactive Detection, Composite Exclusions and Watch List Management, Lifecycle Provider Risk Scoring, Enterprise Case Management (ECaM) and Enterprise Program Integrity Reporting. Digital Harbor is the only COTS ECaM platform, being used within both Medicare and Medicaid contracts. |
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Verisys Corporation
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4817-B Eisenhower Avenue
Alexandria, VA 22304
Phone: 800.718.5753
Website: www.verisys.com
Email: info@verisys.com Verisys Corporation, formerly GMS, Inc., with its flagship product, FACIS™, Fraud and Abuse Control Information System, has been continuously serving the health care community since 1992. Founded by a former Inspector General from the Department of Health and Human Services (DHHS) and the former Assistant Secretary and Acting Undersecretary of DHHS, Verisys delivers best-in-class compliance and data products and services. Verisys delivers mission-critical information accurately to ensure regulatory compliance, minimize legal and reputation risk and prevent health care waste, abuse, and fraud. Verisys is a “primary source” data aggregator of medical provider demographic data (UPIN, NPI, SSN-DMF), licensing (including DEA/CSR), sanctions, exclusions and debarments at both the federal and state level. Verisys gathers data on people, professionals and businesses engaged in the delivery of health care goods and services - - across the entire provider taxonomy - - in all 50 states, the District, and U.S. Commonwealths and Territories. We protect our customers by helping verify, validate; and authenticate health care persons, professionals, affiliates, contractors and vendors. Verisys is NCQA Certified for the following verification services: Medical Board Sanctions, Medicare/Medicaid Sanctions and Ongoing Monitoring of Sanctions and an URAC accredited Credentials Verification Organization.
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