Detect Fraud, Waste & Abuse in Healthcare, Finance & Government Programs

Fraud, waste, and abuse (FWA) are pervasive challenges in our society, across both public and private sectors. It is a complex and extensive problem that requires innovative, robust solutions that can both mitigate and stay ahead of FWA. In the healthcare sector, the COVID-19 pandemic has emboldened scammers seeking to defraud healthcare driven government agencies, organizations, programs, and consumers. Undetected FWA needlessly inflates government healthcare program costs, which squanders hard-earned taxpayer dollars. The sheer volume of healthcare claims, clinical records, reimbursements, and other data flowing in and out of healthcare programs makes detecting FWA extremely challenging, resource intensive, and costly. For example, Medicare now processes and pays an estimated 4 million Medicare Fee-For-Service (FFS) Claims per day and almost 1 billion claims annually. But of the claims processed and paid every year, fewer than 3 tenths of 1 percent receive any form of medical record review, making it hard to efficiently detect improper payments, provider/supplier errors, and non-compliance with rules and accepted practices on a large scale.

healthcare fraud, waste and abuseReduce Financial Losses, Optimize Service Quality

Solving these FWA “big data” challenges requires smart solutions that combine data science expertise with accurate, relevant data, and innovative advanced analytics techniques, such as artificial intelligence and machine learning (AI/ML), and analytics process automation (APA). Enterprises in every industry are leveraging Reveal’s advanced analytics and analytics process automation (APA) solutions to successfully detect fraud, waste and abuse related activities, actors, patterns, anomalies, and errors in payments, claims and other areas of their business. Emerging technologies, aided by high processing power, are empowering organizations to hone their FWA detection and improve mitigation efforts to achieve better outcomes.

Why Reveal?

Reveal designs, implements, and manages effective big data and advanced analytics solutions combined with a robust technology platform that can automate the process of ingesting, mapping, integrating, normalizing, and analyzing structured and unstructured “big data” from a variety of sources. Leveraging powerful analytics techniques, such as artificial intelligence, machine learning, predictive modeling, convolutional neural networks, natural language processing, and deep learning algorithms enables agencies and organizations to increase their ability and timeliness to detect FWA, including instances that had previously been undetectable. Reveal applies sophisticated analytics expertise and techniques, combined with robust APA and other technology products, to solve complex, real world challenges while embracing open-source, technologically agnostic, agile development principles. We streamline and automate labor intensive analytics processes, eliminating thousands of hours of tedious tasks, such as conducting manual FWA audits. Our solutions can tremendously expand FWA and non-compliance audit coverage and detection, compared to limited, randomly selected reviews that leave millions of dollars subsumed by FWA.

Bring Us Your Toughest Big Data Analytics Challenge

Our clients value our expertise and advanced analytics solutions because we use quality data, innovative online analytical processing, data mining, complex event processing, business performance management, benchmarking, text mining, predictive analytics, and prescriptive analytics, among other techniques, that deliver actionable results. Reveal solutions utilize creative and effective techniques that agencies and organizations need to interpret and leverage large volumes of disparate data and formats to make processes more efficient, produce better, cost-effective outcomes, and improve decision-making.