How much can you potentially detect & prevent with FraudLens Dental?
Use our FWA calculator to see how many dollars you can keep. Because FraudLens seeks to prevent FWA activity in the future, the results from our FWA calculator represent DOLLAR FOR DOLLAR SAVINGS. While many “pay and chase” solutions claim to achieve very high dollar amounts, these are dollar amounts that you have already paid to the fraudsters. The actual dollars that you MAY RECOVER some time in the FUTURE will be PENNIES ON THE DOLLAR.
Dental fraud, waste, and abuse (FWA) is often overlooked by payers. This is because most healthcare insurers cover dental services as an adjunct to their medical insurance: dental insurance represents 10% or less of their total business. Thus the losses due to dental FWA represent only 10% of the losses to all healthcare FWA. It is easy to understand why the insurers focus on the 90% due to medical fraud. However, dental fraud still amounts to billions of dollars in losses so even a small reduction in FWA results in millions in savings.
In early pilots, by applying the basic FraudLens principles to the problem of dental FWA, FraudLens has discovered many Billions of Dollars in addressable FWA for the year 2014 looking at only 9 specific patterns of fraud. In most of these, the detection occurred in less than 24 hours and pinpointed a specific treatment with a specific patient on a specific date by a specific dentist. The report of the specifics of the FWA event also included why this was determined to be FWA and how we detected the FWA event. In short, we specify who, what, when, where, how, and why all within 24 hours.
These results are shared with the provider, either through your existing ways of provider communication or through our state of the art Provider Relationship Management (PRM) platform,along with suggestions for remediation, i.e. the proper way to submit claims. If you use the FraudLens Provider Relationship Management (PRM) platform, all subsequent communication is tracked and monitored for effectiveness in getting the provider to improve their claims submissions in the future. If the provider is non-responsive to the early, non-confrontational communication, our Provider Relationship Management (PRM) platform escalates the tone of the communication. Each escalation is meant to prove to the provider that we can continually detect this FWA and that the only remedy is to stop submitting these FWA claims. Our goal is to getting the provider to stop sending fraudulent claims and submit only legitimate claims. This, in turn, will reduce the FWA drastically and will add a lot of savings from claims payout in your bottom line.
FraudLens is actively developing algorithms and solutions for the following areas in the healthcare market including: medical outpatient, durable medical equipment, skilled nursing facilities and hospice, etc.
Within the Medical Outpatient sector, we focus on high cost verticals. FraudLens identifies a vertical as a set of patients with a common theme and who share common concerns. Current FraudLens verticals focus on chronic disease conditions like diabetes, asthma and COPD, heart disease, and arthritis as well as other practice areas including obstetrics and gynecology.
Chronic diseases account for 86% of all healthcare expenditures. Obstetrics and gynecology takes into consideration 50% of the population for a significant portion of the patient’s lifespan. In both verticals, the FWA occurrence is precisely what FraudLens was designed to detect and prevent, i.e. small dollar amounts over a large population that occurs on a regular basis by a large number of providers.