Financial losses due to healthcare fraud are estimated in the tens of billions of dollars each year. Mandated processing efficiencies, overlooked claims, overwhelmed or insufficient staff, disparate record systems, and incomplete reports and data sets can all create opportunities for fraud, waste, and abuse (FWA).
Designed with clinicians, claims and regulatory experts, administrators, and data analysts, Verscend’s FWA solutions adapt to emerging fraud schemes and compliance requirements. Having a complete and integrated solution set means that data analysis, decisions, and insights from one module can help modify rules and algorithms for other modules—creating an even stronger, anti-fraud solution.
Our solution overview explores how Verscend’s FWA Solutions help health plans:
- Anticipate and prevent FWA by identifying aberrant utilization patterns, coding mismatches, and billing-payment activities
- Support post-pay detection by examining utilization measures, financial profiles, and high-impact fraud schemes to identify suspicious activity
- Capture and report investigative details to efficiently manage and track caseloads
- Support advanced data mining and analytics to better assemble vast data and reporting outputs for stronger exploration