Beyond Strategy: FWA and Data

by Verisk Health

Health plans need more than a standard post-payment recovery strategy to keep pace with the schemes and trends of today's fraudsters. Learn more about the innovative ways Verisk's clients are leveraging data to reveal patterns in their early fraud detection and prevention efforts.

How Predictive Analytics Help Cut Medicaid Fraud

by BAE Systems

In 2011 $2.27 trillion was spent on healthcare in the United States. The FBI estimates that a staggering 3-10% of this amount is fraudulent, which works out to an incredible $70 billion to $240 billion of fraud per year. See how advanced predictive analytics and social network analytics can help significantly reduce these numbers.

Game-Changing Medicaid Fraud Prevention

by LexisNexis

Until recently, Medicaid Fraud Control Units (MFCUs) were unable to leverage federal funds to mine Medicaid data for the purposes of detecting and mitigating fraud. However, the rules have changed and that restriction has been lifted.

Public Records for Health Care

by LexisNexis

The United States now spends about $2.6 trillion annually on health care (17.5 percent of GDP) and with the reform initiatives under the Affordable Care Act (ACA), the number of Americans covered and the amount spent will grow dramatically, potentially leading to even greater fraud, waste and abuse in the system.

Revolutionizing FWA detection with a fully integrated software solution - FWAShield

by Healthcare Fraud Shield

Healthcare Fraud Shield is a provider of dynamic fraud, waste and abuse detection software solutions that have dominated the complex financial services industry over the past fifteen years. Our suite of products introduces several new technology applications to the healthcare industry that will revolutionize cost reduction opportunities. Read more to find out about our products and services.

Case Study: Humana's Fight Against Fraud

by Verisk Health

"Humana wants to lead the industry in stopping fraud up front," says Jean Sexton, Area Director for the Humana Special Investigations Unit (SIU). Sexton asserts Humana's commitment to fighting fraud is long-standing and proactive. Rather than relying on data mining flags to simply stop damage from getting worse, Humana aims to eliminate fraud. Since implementing Verisk Health's fraud solutions, referrals to the SIU have increased steadily. Humana's referrals are up thirty percent from a year ago. According to Sexton, the dollar amounts decreased as the number of cases increased. "We're catching it up front so we're reducing waste caused by fraud."