Fraud Solutions Index

NHCAA's Platinum, Premier and Supporting Members are leading providers of products & services to the health care anti-fraud industry, are valued partners who support our mission, and have demonstrated outstanding commitment to the fight against health care fraud.

 

PLATINUM SUPPORTING MEMBERS

CGI Federal Inc.
1001 Lakeside Avenue
Suite 800
Cleveland, Ohio 44114-1151

Phone: 410.279.0996
Website: www.cgi.com/healthcare
Email:healthcompliance_BD@cgifederal.com

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CGI, a global IT and consulting company, is an industry leader in identifying improper payments and assisting healthcare payers to control costs. Our fraud, waste and abuse solution, ProperPay, includes data mining functionality, algorithms and edits to identify improper payments and other features that increase efficiencies in the audit and recovery process.

 

Change Healthcare
3055 Lebanon Pike
Nashville, TN 37214

Phone: 615.932.3000
Website: http://www.changehealthcare.com/

 Change Healthcare

Change Healthcare is a leading provider of software and analytics, network solutions and technology-enabled services all designed to enable smarter healthcare. By leveraging our Intelligent Healthcare Network™—the single largest financial and administrative network in the United States healthcare system—payers, providers and pharmacies are able to improve efficiency, reduce costs, increase cash flow and more effectively manage complex workflows. Learn more at www.changehealthcare.com/solutions/payers.

 

Conduent Payment Integrity Solutions
2135 City Gate Lane
Naperville, IL, 60563

Phone: 770.829.1674
Website: www.conduent.com


Conduent

Conduent is the world’s largest provider of diversified business process services with leading capabilities in payment integrity, analytics, recovery, transaction processing, automation and constituent experience. Conduent’s payment integrity solutions combine powerful analytics, on-site audit processes and teams of industry experts to help healthcare payers prevent losses and recover funds quickly and effectively. We address issues across multiple health program areas, including Medical, Pharmacy, Durable Medical Equipment, Home Infusion Therapy, Hospice and Home Health Provider. Conduent provides pharmacy audit and FWA investigations, medical claims overpayment and recovery services, along with an array of comprehensive cost containment solutions. We work with both commercial and government customers in assisting them to deliver quality services to the people they serve. Learn more at www.conduent.com.

 

General Dynamics Health Solutions 
3211 Jermantown Road
Fairfax, VA 22030

Phone: 888.545.8477
Website: www.gdhealth.com/fraud
Email: info@gdhealth.com

General Dynamics

General Dynamics Health Solutions offers the combination of investigative and clinical services, robust technology and a deep understanding of healthcare billing, claims processing and fraud, waste and abuse schemes to help protect payers. Through an integrated suite of products and services, we provide public and private healthcare payers with tailored solutions that protect against fraudulent activities, prevent inappropriate payments and aid in recoveries.Led by industry-recognized experts, our capabilities include pre-pay prevention, post-pay detection, advanced analytics, case management and comprehensive investigation services.

 

HMS
5615 High Point Drive
Irving, TX 75038

Phone: 214.453.3000
Website: www.hms.com
Email: brent.sanders@hms.com

HMS

HMS powers the healthcare system with integrity with coordination of benefits, program integrity and eligibility services for payers. HMS's clients include health and human service programs in more than 43 states, product offerings in 49 states and Puerto Rico-- including more than 200 managed care plans -- the Centers for Medicare and Medicaid Services, the Department of Defense, and the Veterans Administration. HMS offers a fully customized prospective and retrospective fraud, waste, and abuse solution which integrates into our client's existing workflow. The solution includes forensic coding and data analytics, behavior pattern and predictive fraud analytics, investigation support, provider score - carding...and much more. As a result of the company's services, our clients recover more than $3 billion a year and save billions of dollars more through prevention of erroneous payments.

 

Healthcare Fraud Shield
16052 Swingley Ridge Road
Suite 200
Chesterfield, MO 63017

Phone: 888.333.8140
Website: www.hcfraudshield.com
Email: info@hcfraudshield.com

HFS

Healthcare Fraud Shield provides new and unique Fraud, Waste and Abuse (FWA) automated solutions to the healthcare industry. Our exclusive data solutions and investigative expertise deliver maximum results in the detection and prevention against fraud. Leveraging our comprehensive fraud experience, we deliver fresh insights and new approaches to combat the largest challenge of our time - the delivery of honest, efficient and compassionate healthcare.

Healthcare Fraud Shield offers a fully integrated Fraud, Waste and Abuse software solution platform called FWAShieldTM that includes PreShieldTM (A pre-payment detection system), PostShieldTM (A post-payment detection system), QueryShieldTM (An ad-hoc querying tool) and CaseShieldTM (A case management system that works cohesively with PreShieldTM, PostShieldTM and QueryShieldTM).

 

LexisNexis
1000 Alderman Drive
Alpharetta, GA

Phone: 866.396.7703
Website: http://www.lexisnexis.com/risk
Email: healthcare@lexisnexis.com

Lexis Nexis

Reduce inappropriate payments and wasteful spending, improve SIU efficiency and increase recoveries by leveraging best in class data and analytics from LexisNexis. Our payment protection solutions enable state/local and federal government agencies and commercial health plans to accurately identify areas of wasteful spending across member, provider and claims workflows. Our technology proactively identifies emerging problems in claims billing and potentially fraudulent activities before payments are made and reveal hidden risks undetected by current processes leading to increased cost savings and improved recoveries.

 

MultiPlan
16 Crosby Dr.
Bedford, MA 01730

Phone: 781-895-3118
Website: http://multiplan.com/

 Multiplan

MultiPlan offers a total healthcare cost containment solution that includes payment integrity, network-based and analytics-based services, helping payers reduce the cost of care and improve competitiveness. Unlike similar products, MultiPlan’s payment integrity services include a personal review by an experienced clinician in addition to automated reviews. This human touch allows us to catch more complex issues indicative of waste and abuse, that go undetected by other products. For over 30 years, we’ve processed claims prepayment. Today almost 1 million providers participate in our networks, partnering with us to control claim costs. This rich history helps us resolve payment integrity issues quickly while minimizing provider abrasion --- all before our clients pay a dime.

 

SAS
100 Campus Dr
Cary, NC 27513

Phone: 919.677.8000
Website: www.sas.com/security

SAS

SAS is the leader in advanced analytics software and services, and the largest independent vendor in the business intelligence market. With SAS® payment integrity solutions, health care organizations can detect suspicious activity, prevent improper payments, and uncover collusion and multiparty fraud schemes. Since 1976, SAS has given customers around the world THE POWER TO KNOW®. 

 

Truven Health Analytics, an IBM Watson Health Company
777 Eisenhower Parkway
Ann Arbor, MI 48108

Phone: 734.913.3432
Website: www.ibm.com/watson/health/government
Email: David.Nelson@us.ibm.com

Truven

IBM Watson Health™ helps state Medicaid programs and federal agencies manage healthcare quality and ensure program integrity. With broad fraud-fighting experience, our unique combination of data-driven enterprise transformation and advanced analytics can help you fight healthcare fraud, waste and abuse at every stage. Our suite of program integrity analytics, tools, and services includes identity verification & enrollment, pre- & post-payment analytics, investigative support, and audit & recovery. For more information, visit: https://www.ibm.com/watson/health/government/.

 

Verscend
10897 S. River Front Pkwy
Suite 200
South Jordan, UT 84095

Phone: 866.269.0238
Website: www.Verscend.com


Verscend

Verscend Technologies (formerly Verisk Health) drives better healthcare outcomes through data analytics. Our payment accuracy, revenue integrity, risk assessment and stratification, and quality improvement solutions help organizations utilize their data so they can efficiently and cost-effectively succeed in the new era of healthcare.

Verscend Payment Accuracy solutions offer payers a continuum of payment accuracy and cost containment services. A convergence of data, technology, and analytics, our suite of solutions leverages another important element—human expertise. From real-time claims editing to fraud detection and prevention, we employ a unique process that drives results. Learn more at www.Verscend.com.

To learn more about our entire suite of payment accuracy solutions, visit www.Verscend.com.

 

PREMIER SUPPORTING MEMBERS

FraudScope
75 5th St NW, Ste 2130
Atlanta, GA 30308

Phone: 770-547-8798
Website: https://www.fraud-scope.com/
Email: info@fraud-scope.com

FraudScope

FraudScope is an AI-assisted platform that accelerates the identification of fraud, waste, and abuse. Our comprehensive claims investigation platform utilizes proven and patented AI-based technology to empower investigators and analysts to derive insights and conduct full investigations of suspect claims. Some of the unique benefits of FraudScope’s offering are as follows:

  1. Smarter Investigation - Intuitive, easy-to-use investigative tool suite enhances productivity by speeding up investigations
  2. Better Detection - Proactive AI automatically identifies fraud schemes, including new and emerging ones, with low false positives before claims are paid
  3. Easier Collaboration - Integrated workflow and case management supports collaboration and sharing across the organization

Optum
13625 Technology Drive
Eden Prairie, MN 55344

Phone: 800.765.6807
Website: www.optum.com
Email: empower@optum.com

OPTUM

Optum is a leading health services and innovation company dedicated to helping make the health system work better for everyone. With more than 85,000 people worldwide, Optum combines technology, data and expertise to improve the delivery, quality and efficiency of health care. Optum uniquely collaborates with all participants in health care, connecting them with a shared focus on creating a healthier world. Hospitals, doctors, pharmacies, employers, health plans, government agencies and life sciences companies rely on Optum services and solutions to solve their most complex challenges and meet the growing needs of the people and communities they serve.

SCIO Health Analytics®
433 South Main Street
Suite 203
West Hartford, CT 06110

Phone: 1.800.653.3144
Website: www.sciohealthanalytics.com
Email: info@sciohealthanalytics.com

SCIO

Based in West Hartford, Connecticut, SCIO Health Analytics® is a leading health analytics solutions company, leveraging the power of healthcare data, predictive analytics, and a team of experts to provide clients with the tools to identify and combat fraud, waste and abuse, decrease costs and missed opportunities, and drive ROI and sustainability. Since 2008, SCIO's commitment to analytics-driven outcomes and health technology has produced $275 million in annual savings for clients across multiple markets which include health plans, employers, specialty vendors, and bioscience firms. To learn more, visit www.sciohealthanalytics.com.

 

SUPPORTING MEMBERS

 

Akerman, LLP
Three Brickell City Centre
98 Southeast Seventh Street
Suite 1100
Miami, FL 33131
Phone: 305 374 5600
Website: www.akerman.com


akerman

Akerman LLP is a top 100 U.S. law firm recognized by Financial Times as among the most forward thinking firms in the industry. Its more than 650 lawyers and business professionals collaborate with the world’s most successful enterprises and entrepreneurs to navigate change, seize opportunities, and overcome barriers to innovation and growth. Akerman is known for its results in middle market M&A and complex disputes, and for helping clients achieve their most important business objectives in the financial services, real estate, and other dynamic sectors across the United States and Latin America.

Akerman’s Fraud and Recovery Practice Group provides comprehensive fraud management services, representing insurers, retailers, investors, financial institutions, and others affected by organized fraud, with a particular focus on investigating and seeking recovery for large scale healthcare fraud. As one of the first U.S. law firms with a national focus on fraud and recovery, we are valued for our multi-jurisdictional experience and deep sector knowledge. Our work has resulted in the creation of new laws aimed at reducing future financial losses for payers and the establishment of new guidelines for courts nationwide. We are ardent advocates for our clients and, as a multidisciplinary team, we provide seamless representation throughout the entire fraud and recovery process.

AmerisourceBergen
500 North State College Blvd
Suite 900
Orange, CA 92868

Phone: 610.727.7000
Email: solutions@amerisourcebergen.com
Website: www.amerisourcebergen.com/

AmerisourceBergen


AmerisourceBergen is a leading global healthcare solutions company. The company drives innovative partnerships with pharmacies, health systems, practices and manufacturers to improve product access, increase supply chain efficiency and enhance patient care. Customers count on AmerisourceBergen for comprehensive services and solutions across the healthcare supply chain — from commercialization and distribution to pharmacy, health system, practice and manufacturer solutions. The company’s extensive knowledge, global reach and innovative partnership philosophy enable them to help customers capitalize on the dynamic changes in healthcare. With more than $120 billion in annualized revenue, AmerisourceBergen is the leader in global sourcing and distribution and employs approximately 16,000 employees worldwide from their headquarters in Conshohocken, PA. AmerisourceBergen. Where knowledge, reach and partnership shape healthcare delivery. For more information, visit www.amerisourcebergen.com

 

Context 4 Healthcare, Inc.
55 Shuman Blvd., Ste 650
Naperville, IL 60563

Phone: 800-783-3378
Website: www.context4healthcare.com

Context4

Context 4 Healthcare is the leading provider of cloud-based healthcare compliance solutions in verifying medical claim accuracy for health plans and benefits administrators. These solutions are designed to review for complex coding accuracy, identification of potential fraud, waste, and abuse (FWA) situations before the claim is paid, and to review for potential FWA situations in claim history. Context's Medical Director and our team of certified claim experts maintain solution rules weekly for up-to-date compliance and identification of potential new FWA schemes. The semi-annual creation of our proprietary UCR fee schedules is also a source for identifying potential FWA situations leading to new solution rules, a capability unique to Context. Our experts also blog for your benefit, letting you know about emerging situations that may affect your compliance, and what Context is doing about it. Since 1988, Context has been the healthcare industry's leading compliance specialist.

 

Experian
475 Anton Blvd.
Costa Mesa, CA 92626

Phone: 714.830.7000
Website: www.experian.com/business-services/business-services.html
Email: Bradley.uhlenhoff@experian.com

Experian

Experian unlocks the power of data to create opportunities for consumers, businesses and society. At life’s big moments – from buying a home or car, to sending a child to college, to growing a business exponentially by connecting it with new customers – we empower consumers and our clients to manage their data with confidence so they can maximize every opportunity.

We gather, analyze and process data in ways others can’t. We help individuals take financial control and access financial services, businesses make smarter decision and thrive, lenders lend more responsibly, and organizations prevent identity fraud and crime.

For more than 125 years, we’ve helped consumers and clients prosper, and economies and communities flourish – and we’re not done.

Our 17,000 people in 37 countries believe the possibilities for you, and our world, are growing. We’re investing in new technologies, talented people and innovation so we can help create a better tomorrow.

 

MITRE
202 Burlington Rd
Bedford, MA 01730-1407

Phone: 781.271.2000
Website: http://mitre.org/

MITRE

MITRE is a not-for-profit organization that operates research and development centers sponsored by the federal government.

We operate FFRDCs-federally funded research and development centers-which are unique organizations that assist the United States government with:

  • Scientific research and analysis
  • Development and acquisition
  • Systems engineering and integration

We also have an independent research program that explores new and expanded uses of technologies to solve our sponsors' problems.

MITRE's Sole Focus Is to Operate FFRDCs

MITRE is chartered to work in the public interest. We have no commercial interests. We have no owners or shareholders, and we can't compete for anything except the right to operate FFRDCs. This lack of commercial conflicts of interest forms the basis for our objectivity. We also have the ability to acquire sensitive and proprietary information from the government and industry to inform our work. These organizations are able and willing to share data because they know we won't use it for a competitive advantage.

Moreover, because we operate multiple FFRDCs, we foster a culture of knowledge sharing. We apply what we learn from addressing one sponsor's challenges to similar issues faced by other federal agencies. This means when sponsors engage with us, they have access to all the minds of MITRE.

Verisk Insurance Solutions
1100 West Traverse Parkway
Lehi, UT 84043

Phone: 801-932-8090
Website: www.verisk.com/insurance

Verisk HS

Verisk Insurance Solutions is a leading source of information about property/casualty insurance risk. Drawing upon unique data assets and deep domain expertise to provide innovative solutions that are integrated into customer workflows, Verisk Insurance Solutions includes the industry-leading brands of ISO, AIR Worldwide, and Xactware. Around the world, Verisk Insurance Solutions helps customers protect people, property, and financial assets. For more information, visit www.verisk.com/insurance.

Verisys® Corporation
1001 N. Fairfax Ave
Suite 640
Alexandria, VA 22314

Phone: 888.837.4797
Website: www.verisys.com
Email: info@verisys.com

Verisys NEW

Verisys® provides health care compliance professionals with the tools they need to prevent waste, abuse, and fraud committed by high-risk people, professionals, and businesses. We are the leading provider of sanctions, exclusions, and disciplinary actions. Our flagship product, FACIS®, offers a full complement of primary sources to monitor licensure, DEA, criminal, sex offender, abuse registries, and more.