March 07 2017 | 0 Comments | 231 reads Average Rating: 4

Survey Says Organizations Rely on Narrow Swatch of Data to Combat Fraud, Waste & Abuse

by SCIO Health Analytics in Payment Integrity

During a recently held webinar titled Predicting and Preventing Claim Fraud, Waste and Abuse with Advanced Profiling & Analytics, insights were provided by speakers Rodger Smith, SVP, Payment Integrity and Rena Bielinski, SVP, Strategic Accounts on a variety of topics including: new and emerging challenges facing payers; the need to progress beyond claim level analysis for fraud, waste and abuse (FWA); how to apply predictive models and rich data benchmarks to better identify true outliers; the impact of analytics and profiling on FWA; and more.

The webinar also provided the opportunity to gather some insights from audience members on the state of FWA efforts within their organizations. The following was uncovered through the opinion poll:

#1 Even though FWA is a growing challenge, nearly all of the respondents rely on claims data (98%) to identify potential FWA patterns while far fewer leverage other types of information.

#2 Organizations are still not optimally using a full range of data – as only 35% of poll participants cited realizing FWA outcomes from multi-source data.

#3 About half of all respondents use a combination of internal teams and external vendor tools in the FWA efforts, which means that about half either are not sure of what their organizations use or don’t use either.

These poll results provide a glimpse into the state of FWA initiatives at healthcare organizations. Where does your organization stand with its FWA prevention programs – and what are you doing to improve your efforts?

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Arun Rangamani
SVP, Care Optimization and SCIOXpert Services

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David Hom
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Dr. Kevin Keck
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Jen Cressman
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John Pagliuca
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Jonathan Niloff, MD (Guest Author)
President, Niloff Healthcare Strategies, LLC

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Vice President, Analytics

Lesli Adams, MPA (Guest Author)
Director of Population Health Strategy, Oracle Corporation

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Director of Compliance & Risk Adjustment, Scripps Health Plan Services

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Nicole Cormier
Senior Manager, Home Health

Priyanka Rajkumar
VP - SCIOXpert and Solutions, Analytics

Rachel Hall
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Rena Bielinski
SVP, Strategic Accounts

Rodger Smith
SVP, Payment Integrity

Rose Higgins
President, North America

Subha Vaidyanathan
VP, Technology and Data Management

Taryn Bevilacqua
Compliance Director

Tom Peterson
SVP, Risk Adjustment


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