Fraud, Waste, and Abuse Services
Because our concern is the clinical value of the data exchange that takes place among healthcare agencies, providers, plans, and healthcare systems, we develop analytics tools that make this possible.
The analytics tools will provide will help Medicaid agencies to understand how they spend every dollar – managed care plans, fee-for-service claims, or other novel value-based payments. The understanding of how they spend each dollar will help them identify any inefficiencies (or fraud) in their operations.
The nature of Medicaid means integrity and fiscal accountability is a primary objective. Through these analytics tools, Medicaid agencies can achieve that goal as they identify inefficiencies (and fraud) and develop strategies to block the hole (especially in light of new Centers for Medicare and Medicaid Services [CMS] regulation).