Healthcare payers must be able to detect and deter those few providers and beneficiaries who attempt to abuse or defraud their systems. While these individuals are few in number, the associated losses are substantial, and worst of all – they take money away from being able to serve the health needs of your population.
State Medicaid and Federal agencies that can quickly access and analyze their program’s healthcare data are better positioned to provide high quality care to beneficiaries while insuring Program Integrity.
Healthcare data, and their relationships with one another, are complex. For detection and investigation of healthcare fraud, waste and abuse vulnerabilities, having robust data mining capabilities that address the challenges of performance, flexibility and adaptability are key to efficient and productive analysis.
Medical Episode Grouper
The Medical Episode Grouper® (MEG) enables government agencies to
The Truven Health Analytics MarketScan® Research Databases provide access to fully integrated, de-identified, individual-level healthcare claims data that can be used to examine health economics and treatment outcomes. They are the gold standard in proprietary U.S. healthcare databases.
Transformational healthcare solutions from Truven Health Analytics are now offered by IBM Watson Health