Program and Integrity | Fraud and Abuse Detection |  Payment Integrity Enterprise™
PROGRAM INTEGRITY

Fraud and Abuse Detection Services

Fraud and abuse continues to take its toll on programs in Federal and State government around the country — with an estimated $1 out of every $10 spent on healthcare attributed to questionable activity.   With the onslaught of new covered patients coming on board in 2014, it’s more important than ever to have an intelligence-based program integrity plan in place to combat fraud and abuse across the payment continuum.

For more than 30 years, our solution have helped our clients recover hundreds of millions of dollars.  Our Payment Integrity EnterpriseTM suite of solutions addresses all of the following areas – and your program sees the results.

 
Get to know the Payment Integrity Enterprise

 

Prepay Review and Prevention
Proactively target high risk claims and providers for intervention up stream in the payment process using; innovative predictive models, efficient workflow management, and powerful forensic review tools that arm your team with information to take action

Provider Surveillance and Compliance
Improve the efficiency of monitoring your existing providers, preventing risky providers from entering your network, and compliance with contracts.

Case Management
Encourage organizational collaboration, high quality, and efficiency for case pursuit and resolution.

Advanced Predictive Models and Algorithms
Apply the power of advanced fraud detection methods, patent pending predictive analytics, and industry-leading business intelligence tools to improve your program integrity results.

Investigative Services Including Site Visits
Get the expert support you need for efficient and complete case development and resolution.

Truven Health clients include more than half of the State Medicaid agencies, as well as the Federal Government. We’re known for our comprehensive program integrity solutions, including superior data management, analytics, software tools, and expert consultants who have a passion for program integrity excellence.

A message from our Vice President for Payment Integrity Solutions




The bottom line — We help you find the answers — and your program sees the results.
 

Learn more about our Payment Integrity Enterprise suite of solutions
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Prepay and Prevention Investigative and Consulting Services Predictive Analytics, Algorithms and Reporting Provider Surveillance Case Management