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technology, clinical power, and a unified health plan deliver better results, together

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November 02, 2017

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.

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This myopic approach to fraud, waste, and abuse (FWA) fosters siloed thinking and inefficiencies. Payers are far better served by a collaborative approach, one where human expertise and advanced technology together help reduce false positives and deliver more actionable case referrals. And one where a single data stream and interface effectively unify claims operations and special investigations units (SIU)—for better results and return on investment.

 

We hope you’ll join Verscend in Orlando, Florida, at the National Health Care Anti-Fraud Association’s (NHCAA) Annual Training Conference November 14–17, 2017, the premier anti-fraud industry event. We’ll be at booth #101, showcasing how advanced technology and clinical expertise deliver better results, together.

 

Verscend’s collaborative team of data scientists, clinicians, and investigators develops and maintains multiple levels of analytics to detect outlier billing behavior. Our analytics evolve along with creative fraudsters and the changing healthcare landscape.

 

Backing up our analytics are our people. Providing an unvetted list of analytic triggers to an SIU can cause investigators to spend an average of 65 percent of their time reviewing false-positive results. Verscend employs a dedicated team of clinical analysts and fraud experts within our own clinical investigations unit (CIU) to review and validate our system results prior to sending them to the client’s SIU. Clients can then focus on only the providers and claims identified as suspect, reducing wasted time on false positives and increasing case open rates.

 

Don’t take our word for it: Join us at NHCAA and see it in action. You won’t want to miss this opportunity to take your anti-fraud efforts to the next level—and watch your savings increase.

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Ryan Cleverly is responsible for directing Verscend’s Fraud Operations team, made up of fraud analysts who leverage Verscend’s proprietary analytics to identify potential fraud for clients. He was previously a criminal investigator for the State of Utah’s Insurance Fraud Division, where he investigated allegations of all types of insurance fraud, including healthcare fraud, pharmaceutical drug diversion, and staged automobile accidents. He was also assigned to the FBI Health Care Fraud Task Force, which focused on the illegal diversion of controlled substance pharmaceuticals and provider fraud, where he conducted multiple complex healthcare fraud investigations. Ryan is an Accredited Health Care Fraud Investigator (AHFI) and has a bachelor’s degree in communication and a master’s degree in strategic communication.

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