Those who seek to commit healthcare fraud and abuse are continually adapting. Often, they fly just under the radar with billing behavior that's not quite bad enough to be identified by claim systems looking at just a single provider or within just one payer's claim patterns. At the same time, the increasingly complex healthcare landscape presents fresh opportunities for new or continuing areas of wasteful and erroneous billing.
Verscend Technologies Fraud Detection solution combines advanced analytics and clinical investigative review to deliver actionable case referrals to cost containment staff and special investigations units (SIU). The result is pre- and post-pay protection from aberrant billing and known and emerging fraud schemes. Clients who self-report savings to us, per their process and accounting practices, report savings of between $0.40 and $1.70 PMPM.