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Waste, fraud, and abuse analytics

An estimated $600 to $850 billion of annual U.S. healthcare spending is attributable to waste of some kind. Even more disheartening is the fact that $275 billion of that waste - nearly $9,000 per second - is likely due to fraud, abuse, and administrative inefficiencies.

The good news?
Truven Health Analytics offers the most advanced predictive models and algorithms to identify and reduce claims waste, fraud, and abuse. Our proven detection methods and powerful analytics help you stay on top of ever-emerging and cleverly concealed schemes.

Our proprietary algorithms and models are not only wide-reaching and current, but they also have embedded clinical intelligence and flexibility for tailoring to specific characteristics; especially those with the highest potential according to our MarketScan research:

 

  • Multiple new patient office visits to the same provider for the same patient
  • Diabetic supplies for members without diabetes
  • Ambulance trips to nowhere
  • Schedule II narcotics without physician care
  • Refills of Schedule II narcotics
  • Code pair violations

 

Each of our detection algorithms is assigned to one of five categories of vulnerability: Recoverable, Potential Savings, Requires Further Investigation, NCCI Edits, or Improper Billing. These categories make it easy to guide recommendations for further action in the most cost-effective manner.