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 Customized Audit System (CAS) includes data mining functionality, algorithms and edits to identify improper payments and other features that increase efficiencies in the audit and recovery process.

 

Emdeon
3055 Lebanon Pike
Nashville, TN 37214

Phone: 877.EMDEON.6
Website: www.emdeon.com/paymentintegrity/
Email: moreinfo@emdeon.com

Emdeon

Emdeon EDGE is one of the industry's most complete suites of payment integrity services. Our solutions easily integrate within your existing claims workflow, from pre-payment to post-payment, and provide multi-layered protection that offers both prospective and retrospective claims review, as well as in and out-of-network claims management. Achieve superior claims cost containment and the payment integrity your business needs - how you want it, when you want it. With Emdeon EDGE, when you pay a claim, you can trust it is a claim worth paying.

 

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 
One West Pennsylvania Ave
Suite 700
Baltimore, MD 21204

Phone: 410.832.8300
Website: www.gdit.com/fraud
Email: info@gdit.com

General Dynamics

General Dynamics Health Solutions is a leading provider of healthcare IT, informatics and consulting solutions that help government and commercial health plans improve patient outcomes, enhance market position and reduce costs.

General Dynamics HS helps protect healthcare program integrity with our STARS®Solutions Suite, a comprehensive product and service offering to combat fraud, waste and abuse (FWA). The Suite includes STARS®Sentinel our FWA lead generation tool; STARS®InformantT for ad-hoc data exploration to fully support the investigative process; STARS®Interceptor for pre-pay fraud prevention; STARS®CommanderT our state-of-the-art case management and reporting system; and STARS®Services, our team of seasoned healthcare fraud experts who can augment your Special Investigations Unit staff or provide consulting services to strengthen your FWA program. General Dynamics HS also offers a broad range of solutions from HEDIS® compliance reporting and physician performance measurement to the soundest ICD-10 solution in the marketplace.

General Dynamics HS provides solid results, offering a proven track record, unparalleled customer service, and a quality-driven focus that supports efficient, consumer-directed and real-time enterprises. Learn how the General Dynamics IT team is enabling connections and applying experience to improve outcomes at www.gdit.com/fraud.

 

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

SAS

SAS is the leader in advanced analytics software and services, and the largest independent vendor in the business intelligence market. With SAS®, health care organizations can detect suspicious activity and uncover collusion and multiparty fraud schemes. Since 1976, SAS has given customers around the world THE POWER TO KNOW®. www.sas.com/security.

 

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
Email: pad@veriskhealth.com


Verisk

Verisk Health is the leading provider of real-time, clinically validated payment accuracy solutions. PhysicianClaim Insight is a customizable, sub-second editor that employs over 17 million AMA and CMS rules to deliver the utmost transparency and accuracy. Fraud Finder Pro leverages predictive modeling, link analysis and a proprietary provider-scoring model for complete prevention of fraud, waste and abuse. Each solution is powered by our next-generation software, Nucleus, and leverages our unique clinical validation process. Our doctors, nurses, dentists and SIU teams employ their experience, intellect and intuition to provide the most accurate payment recommendations imaginable.

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

 

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.

 

Health Care Excel
2601 Metropolis Parkway
Suite 200
Plainfield, IN 46168

Phone: 317.347.4500
Fax: 317.347.4567
Email: info@hce.org
Website: www.hce.org


Health Care Excel

Health Care Excel improves health care processes and outcomes by providing expertise in a variety of clinical arenas, focusing particularly on the area of fraud, waste, and abuse prevention. Health Care Excel has over 39 years of experience in program integrity, utilization review, and fraud, waste, and abuse prevention. Leveraging our coast-to-coast teams of clinicians and our state-of-the-art software, Health Care Excel has helped our clients recoup tens of millions of dollars. Additionally, Health Care Excel has worked with the Office of the Inspector General in multiple states to provide audit services for potential fraud and abuse cases. Health Care Excel serves clients in the private sector and in federal and state governments.

 

IBM
150 Kettletown Road, MD#223
Southbury, CT 06488

Phone: 866.757.1105
Website: www.ibm.com/smartercounterfraud
Email mandy@us.ibm.com

IBM

IBM has over 100 years of technical leadership in helping businesses and government agencies innovate by holistically bridging business and IT strategies. Leveraging the latest advancements in analytics, along with deep industry and business expertise, IBM is uniquely positioned to help organizations not only handle, but pro-actively anticipate, prevent and continuously adapt to threats.

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

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

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

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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
5 Country View Road
Malvern, PA 19355

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

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.