CERIS Announces Enhanced Offering to Fraud, Waste, and Abuse Solutions
August 27 2024 - 7:41AM
Today, CERIS, a CorVel Company, has announced advancements to its
current Fraud, Waste, and Abuse (FWA) solutions, including earlier
detection capabilities and improved behavioral analytics. These new
integrations and services will expand on CERIS’ current FWA
offering for customers as they navigate a complex healthcare
industry and work to better manage and mitigate prevalent fraud and
risk issues in today’s landscape. Through identity and behavioral
analytics, scanners, dashboards, reporting, and FWA consulting,
CERIS’ enhanced solutions are automating detection and errors in
billing to aid payers in prevention and remediation.
The National Health Care Anti-Fraud Association (NHCAA)
estimates that financial losses for healthcare organizations are in
the tens of billions of dollars each year. A leader in payment
integrity, CERIS works closely with providers to overcome
challenges and false payment methods through its FWA products.
Today’s enhancements will support the following:
- Fraud Case Analytics - SIU and Suspicious Activity Lead
Services: Case data analytics will utilize client and
industry data for rapid analysis and reporting through machine
learning capabilities
- Fraud Scanners: A suite of data scanners will
detect suspicious activity on pre- and post-pay claims offering
clients lead detection for Fraud, Waste & Abuse
- Fraud Dashboard & Reporting: CERIS will
offer flexible reporting options on client analysis and results
through industry standard tools
- FWA Consulting: CERIS will bring its expertise
in prevention, remediation, and operational efficiencies of payment
processing in support of Fraud, Waste & Abuse management
“With today’s new advancements across FWA, CERIS is excited to
support the entire enterprise, from workers’ compensation,
government payments to group health, and beyond,” said Mark
Johnson, Senior Vice President, Product Development at CERIS.
“These enhancements will automate fraud, waste, and abuse detection
within claims data through solutions that are completely
customizable for CERIS customers. We are able to bring in disparate
data sets – across medical claims and beyond –for customers who are
eager and committed to preventing fraud across their
organization.”
Over the past twelve months, CERIS analyzed over 1.1 billion
claims, and from this set, 1.6 million of the claims were flagged
as open to questioning, uncovering more than $700 million in
suspicious medical billing via CERIS’ behavioral intelligence
analytics solution. The results also showed that claims under $500
are a major source of fraud and often go undetected. More details
can be found in CERIS’ recent case study. The study has also
allowed CERIS to develop different categories of risk to help
prioritize investigations for its clients.
“At CERIS, we are committed to ensuring the proper practices are
followed in the healthcare industry and that payers are aware of
any suspicious actors deemed unethical. That is why we are proud to
announce today’s enhancements to our FWA offering,” said Debra
Hamer, Director of Product Management for Healthcare Fraud, Waste,
and Abuse at CERIS. “These improvements will allow our team to
enable and foster responsibility for fraud protection across the
healthcare industry.”
About CERISCERIS, a leader in both prospective
and retrospective claims review and repricing, combines clinical
expertise and cost containment solutions to ensure accuracy and
transparency in healthcare payments. Accuracy and validation
services include itemization review, DRG validation, facility
repricing, contract and policy applications, review of implants and
devices, and primary payer cost avoidance. Its universal
chargemaster contains billions of charge items from more than 97%
of the nation’s hospitals, helping to ensure the accuracy and
objectivity of each claim review.
Safe Harbor Statement under the Private Securities
Litigation Reform Act of 1995All statements included in
this press release, other than statements or characterizations of
historical fact, are forward-looking statements. These
forward-looking statements are based on the Company’s current
expectations, estimates, and projections about the Company,
management’s beliefs, certain assumptions made by the Company, and
events beyond the Company’s control, all of which are subject to
change. Such forward-looking statements include, but are not
limited to, statements relating to the Company’s payment review
services and the Company’s continued investment in these and other
innovative technologies, and statements relating to the Company’s
service offerings. These forward-looking statements are not
guarantees of future results and are subject to risks,
uncertainties, and assumptions that could cause the Company’s
actual results to differ materially and adversely from those
expressed in any forward-looking statement, including the risk that
the impact of the COVID-19 pandemic on our business, results of
operations and financial condition is greater than our initial
assessment.
The risks and uncertainties referred to above include but are
not limited to factors described in this press release and the
Company’s filings with the Securities and Exchange Commission,
including but not limited to “Risk Factors” in the Company’s Annual
Report on Form 10-K for the year ended March 31, 2024, and the
Company’s Quarterly Report on Form 10-Q for the quarters ended
September 30, 2023, December 31, 2023 and June 30, 2024. The
forward-looking statements in this press release speak only as of
the date they are made. The Company undertakes no obligation to
revise or update publicly any forward-looking statement for any
reason.
Contact: Melissa StoranPhone: 949-851-1473www.ceris.com
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