Fraud Prevention

Cyber Security

Outcomes

Fraud in health care and care delivery is just as prevalent as in any other economic sector. Fortunately, majority of these fraudulent activities are committed by a very small minority of health care providers. Unfortunately, their actions do impact most, if not all, of the trusted and respected physicians.

Cognizance Technologies (CT), realizing, the far-reaching effect of fraud in health care and the risks it poses to different aspects of the space, has gained significant experience by working with its partners and clients. CT has developed numerous technological methods to help prevent fraud by collecting and analyzing data; results of the analysis is then is used to determine outcomes.

Identification

CT works to reduce and prevent questionable providers and suppliers of health care from enrolling in the CMS’ National Medicare program by improving and automating screening mechanisms and procedures through APS – the Advanced Provider Screening program. CT’s solution screens providers and suppliers by automating data checks and developing methods to proactively identify fraud, waste, and abuse.

CT has worked to reduce improper payments by identifying and addressing coverage and coding/billing errors through PERM – CMS’ the Payment Error Rate Measurement program. The solution provided by CT allows multi-level reviews of provider claims by administrative and medical reviewers to prevent accidental or intentional improper payments.

Technological Solutions

CT, having done this work, has a deep understanding of the multitude of types of fraud that can be committed - everything from billing for unperformed services to overbilling to performing medically unnecessary procedures and finally falsifying patient diagnoses. We are constantly extending our knowledge and understanding of fraudulent activities so that we can improve our technological solutions.