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:HealthIT@cgi.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: https://www.changehealthcare.com/
Email:

 Change Healthcare

Emdeon is now Change Healthcare. The Intelligent Health Network connects the dots between payers, providers and patients, giving us the data needed to deliver predictive insights. Our integrative Payment Integrity solution helps payers achieve superior claims cost containment by preventing unnecessary losses related to fraud, waste and abuse. We enable smarter decisions to help you anticipate and navigate change in healthcare so you can focus on what matters most.

 

FICO
181 Metro Drive, Suite 600
San Jose, CA 95110

Phone: 1.800.999.2955
Website: www.fico.com/insurance
Email: info@fico.com

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FICO is a leading analytics software company, helping businesses in 80+ countries make better decisions that drive higher levels of growth, profitability and customer satisfaction. FICO provides analytics and application software for healthcare payers that optimize payments and build more profitable customer relationships across the entire payer enterprise. FICO helps companies significantly reduce fraud, waste and abuse, pinpointing provider and facility contract issues, discovering compliance problems, and creating coordinated two-way mobile communications to members.

 

General Dynamics Health Solutions 
3211 Jermantown Road
Fairfax, VA 22030

Phone: 888.545.8477
Website: www.gdhealth.com
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.

 

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
777 Eisenhower Parkway
Ann Arbor, MI 48108

Phone: 734.913.3432
Website: www.truvenhealth.com/program_integrity
Email: david.nelson@truvenhealth.com

Truven

Truven Health Analytics is dedicated to fighting fraud, waste, and abuse in the U.S. healthcare system. We are a trusted and proven solution provider for numerous payers including government agencies, health plans, and employers. Truven Health delivers unbiased information, analytic tools, benchmarks, and services to the healthcare industry. Our customers have relied on us for more than 30 years. We combine our deep clinical, financial, and healthcare management expertise with innovative technology platforms and information assets to make healthcare better and fight fraud, waste, abuse and overpayment. Our solutions include the application of predictive analytics, network analysis, public records, provider credentialing and surveillance and draws on our extensive algorithm and model library. We collaborate with our customers to uncover and realize opportunities for improving quality, efficiency, and outcomes. We have major offices in Ann Arbor, Michigan; Chicago; and Denver. With broad and deep fraud-fighting experience, Truven Health brings to your organization a high level of expertise and a proven record of delivering results.

 

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

Phone: 866.269.0238
Website: www.veriskhealth.com/answers
Email: pad@veriskhealth.com


Verisk

Verisk Health's Payment Answers offer payers a continuum of payment accuracy and cost containment services. Claim Accuracy combines 17 million open sourced claim edits and a next-generation technology platform with expert, human clinical validation to stop outlier claims prior to payment. The combination of these two offerings gives payers a solution that addresses errors, mistakes, and waste often found in claims adjudication, but also abusive behavior related to modifier and office visit utilization. Verisk Health Fraud Detection bundles provider profiling, predictive modeling, case tracking, and Special Investigations Unit (SIU) services for total protection from healthcare fraud, waste, and abuse. We identify various billing behaviors, coding rule violations, aberrant billing patterns, and known schemes, as well as unknown patterns.

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

 

Xerox
9040 Roswell Rd
Suite 700
Atlanta, GA 30350

Phone: 770.829.1674
Website: http://www.xerox.com/govhealthcare
Email: govhealthcare@xerox.com


Xerox

Xerox specializes in population health and administrative management for healthcare programs. We offer a full suite of auditing solutions that help to 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.

 

PREMIER SUPPORTING MEMBERS

BAE Systems Applied Intelligence
265 Franklin St
Boston, MA 02110-3113

Phone: 617.737.4170
Email: learn@baesystems.com
Website: www.baesystems.com/industry-rai/civil-government/healthcare


BAE



BAE Systems Applied Intelligence delivers solutions which help our clients to protect and enhance their critical assets in the connected world. We provide the healthcare industry with leading-edge technology to achieve a game-changing boost to the effectiveness of pre-pay and post-pay managed care program integrity initiatives, as well as to maximize HIPAA network security compliance. Our NetReveal® solution can operate in real-time to stop the cycle of "pay and chase" by blocking the payment of suspicious claims before the claim is paid or analyze all your managed care programs and risk score the provider in any or all programs . The solution considers every claim in the context of the history of the beneficiary and providers and takes into account any relationship to other parties. Not only are current and future claims stopped, but the behavior is automatically identified by the solution, allowing easy post-pay recovery of previous instances. We are helping our clients to achieve exceptional improvements both in the total volume of aberrant claims detected as well as in the accuracy of detection. Our HIPAA Essential solution includes a full suite of network security compliance technologies, trained personnel, and certified processes to help clients address HIPAA HITECH compliance.

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.

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.

TRICAST, Inc.
10400 W Innovation Dr Ste 310
Milwaukee, WI 53226-4850

Phone: 414.302.9733
Website: www.tricast.com

 

TRICAST leverages its extensive technology and claims processing expertise, extensive client insight and multiple industry experts to offer forward-thinking, full-scope pharmacy benefit oversight solutions. Founded by Greg Rucinski in 1997, TRICAST provides audit and consulting services, and its innovative Reveal software, a web-based pharmacy benefit surveillance and analytics package. TRICAST's expertise and experience enables delivery of comprehensive assessments of pharmacy programs.

 

SUPPORTING MEMBERS

ID Experts
Lincoln Center 1
10300 SW Greenburg Road, Suite 570
Portland, OR 97223

Website: www2.idexpertscorp.com
Email: healthinfo@idexpertscorp.com

Idx Logo W Tag

ID Experts is the leader in comprehensive data breach solutions that deliver the most positive outcomes. The company has managed hundreds of data breach incidents, protecting millions of affected individuals, for leading healthcare organizations, corporations, financial institutions, universities and government agencies. In healthcare, the company contributes to relevant legislation and rules including HITECH and is a corporate member of HCCA and HIMSS. ID Experts data breach preparedness and response services have been endorsed by the American Hospital Association. ID Experts is active with organizations that advocate for privacy for Americans including ANSI/Identity Theft Prevention, Identity Management Standards Panel and the International Association of Privacy Professionals. For more information, visit http://www2.idexpertscorp.com; join in the All Things HITECH discussion via LinkedIn at bit.ly/AllThingsHITECH; and follow ID Experts on Twitter @IDExperts.

McKesson Health Solutions
475 Allendale Rd
King of Prussia, PA 19406

Phone: 800.782.1334
Website: www.mckesson.com
Email: mhs@mckesson.com

McKesson

McKesson helps payers fight healthcare fraud, waste and abuse all along the payment continuum - from adjudication to pre-pay auditing to post-pay recovery. By combining best-in-class rules content, flexible technology, and predictive analytics in a full service delivery model, we ensure that more abusive or wasteful claims can be stopped in claims operations before they are paid, and that SIU's can recover more fraudulent dollars for less effort.

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.