Healthcare Informatics for Fraud, Waste and Abuse Protection

Healthcare fraud, waste and abuse cost the American healthcare system more than $54 billion annually.* No health payer organization can afford to write off this much. Left unchecked, the enormous cost of healthcare fraud, waste and abuse threatens both the quality of healthcare and access to care for millions for Americans. By 2010, the U.S. Department of Health and Human Services/Centers for Medicare and Medicaid Services (CMS) projects that the total cost of healthcare fraud, waste and abuse in the U.S. could reach $260 billion.

Health insurance data converge on claims processing departments from many sources, in various forms and in overwhelming volumes making it difficult to integrate and manage. Data also move even more quickly because of electronic data interchange. As never before, there's a critical need to effectively discover the "fingerprints" fraud perpetrators inevitably leave behind. With STARSSolutions from ViPS®, a General Dynamics Information Technology company, you can do just that. It is a family of powerful fraud, waste and abuse (FWA), protection solutions, from pre-pay fraud prevention to post-pay fraud detection and case management. ViPS' professional consultants can also put powerful healthcare information management and technology expertise at your command.

*2008, National Health Care Anti-Fraud Association (NHCAA), Consumer Info & Action.

STARSSolutions

Our leading overpayment and fraud protection solutions, STARSSolutions, integrates powerful analytic tools, administrative and workflow components plus statistical algorithms for pre-pay prevention, early-warning identification, detection and optimum workload/caseload management. With STARSSolutions Suite, we can help you discern innocent errors from outright fraudulent intent. No other solution in the marketplace provides the same level of detection, automation, in-depth analysis, integrated workflow and ROI. It can serve as a powerful tool in decreasing FWA losses; increasing recoveries; developing provider educational programs; and optimizing operational efficiencies.

STARSSentinel^™
Fraud and Abuse Lead Generation: Spot potential FWA automatically by identifying the most suspicious providers and members.

STARSInformant^™
In-depth Investigative Analytics: Perform ad-hoc data exploration to fully support the investigation process.

STARSCommander^™
Comprehensive Case Management: Manage workload/caseload throughout the life cycle with advanced workflow features and reporting capabilities.

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