Insurance companies today face the challenge of protecting their network against fraud, waste, and abuse while not adversely impacting their Medical Loss Ratio (MLR). Moreover, Special Investigation Units (SIU) face reduced budgets and increasingly strained resources. Fully outsourcing or partially outsourcing components of SIU responsibilities serve as a solution to the budgetary constraints. Healthcare Fraud Shield provides Subject Matter Experts trained to:
- Analyze claims data and develop sustainable cases
- Detect systemic weaknesses
- Investigate cases
- Prevent fraud using edit or policy recommendations, provider/member education and more
Additional HCFS Products and Services
FWAShield utilizes unique and proprietary data sources to maximize Return on Investment (ROI) and achieve superior results.
Reduce dollars lost by preventing ineligible claims to be paid
Monitors claims and suspicious activities through advanced post-payment detection.
Identifies prescription drugs improperly billed based on company policies and guidelines.
Runs real-time queries and complex pattern reports from loaded data.
Automates Case Management, including reporting, tracking, and communications.