Six Degrees of Separation: Fueling investigations with insight into hidden and complex relationships, associations, and affiliations
(Room Balboa A-C)
18 Nov 15
11:00 AM
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12:00 PM
Tracks:
Anti-Fraud Technology Solution
Health care costs continue to rise, affecting everyone involved -- patients, providers, insurance companies and other organizations. While many efforts have been made to control those costs, including the federal government's health care reform law, the Patient Protection and Affordable Care Act, many observers say efforts haven't gone far enough in solving one of the top problems in medicine today: health care fraud, waste, and abuse (FWA). The future of FWA detection involves the overlaying of linking analytics to internal and external data sources. This approach helps uncover significant links among individuals, businesses, assets and properties. Coupling this powerful capability with claims, public records, and contributory data unlocks hidden patterns that otherwise could adversely impact an organization's bottom line, regulatory compliance goals and patient safety. This session will address the importance of looking at providers as people, understanding relationships among providers, patients, and business' and how linking analytics provides visibility into hidden fraud across provider networks.