Media Room

For Immediate Release

Truven Health Supports Recovery of $268 Million in Unnecessary Healthcare Claims

Session at NHCAA Annual Training Conference to Detail Breakthrough Fraud and Abuse Recovery Program

Ann Arbor, MI, Nov. 13, 2012 — Truven Health Analytics℠, will present the results of a breakthrough payment integrity program that has led to nearly $500 million in identified fraud, waste and abuse for one innovative health plan.

The session, Proven Analytics and Innovations to Fight Fraud, will be presented at the National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference on November 15, from 8:45 AM to 10:00 AM. The conference, which is being held in Anaheim, CA, is the nation’s premier anti-fraud event, drawing 1, 300 private- and public-sector healthcare professionals.

Presenters from Truven Health Analytics include Jean MacQuarrie, vice president; Mark Gillespie, senior director; and David Nelson, senior director. They will be joined by representatives from a rapidly growing Medicare Advantage health plan that provides complete coverage for hospital, professional, prescription drug, and care management services.

The team will outline the approach taken by the health plan, which utilized Truven Health’s Payment Integrity Enterprise™ solution to prevent, identify, and recover improper claims in their system. This health plan achieved total program return on investment of more than 50:1.

“Today’s health plans are operating in an unprecedented era of economic and regulatory uncertainty. To compete and thrive in this environment, they need to be able to efficiently remove fraud and abuse from the equation, ” said Jon Newpol, executive vice president, Truven Health Analytics. “We are enormously proud of how we’ve supported this health plan’s success and we look forward to the opportunity to present our experience as a model for the industry.”

According to Truven Health research, approximately $125 to $175 billion is wasted each year on healthcare fraud and abuse. Despite the common myth that fraud and abuse are confined primarily to the public sector programs of Medicare and Medicaid, Truven Health estimates that 5-10 percent of payments in the private health plan market are inappropriate.

For more information on the NHCAA Annual Training Conference, please click here.

For more information on Truven Health Analytics payment integrity solutions for health plans, please click here.

About Truven Health Analytics, part of the IBM Watson Health Business

Truven Health Analytics®, part of the IBM Watson Health™ business, provides market-leading performance improvement solutions built on data integrity, advanced analytics and domain expertise. For more than 40 years, our insights and solutions have been providing hospitals and clinicians, employers and health plans, state and federal government agencies, life sciences companies and policymakers, the facts they need to make confident decisions that directly affect the health and well-being of people and organizations in the US and around the world. The company was acquired by IBM in 2016 to help form a new business, Watson Health. Watson Health aspires to improve lives and give hope by delivering innovation to address the world’s most pressing health challenges through data and cognitive insights.

Truven Health Analytics owns some of the most trusted brands in healthcare, such as MarketScan®, 100 Top Hospitals®, Advantage Suite®, Micromedex®, Simpler® and ActionOI®. Truven Health has its principal offices in Ann Arbor, MI, Chicago, IL, and Denver, CO.


Brian Erni
For Truven Health Analytics
J. Roderick, Inc. Public Relations