Verisk Health Announces Pooled Data Initiative to Fight Healthcare Fraud

August 27, 2013 / 3 min read

Humana and Centene join Verisk Health’s initiative to redefine the fight against healthcare fraud, waste, and abuse

Salt Lake City, Utah, August 27, 2013 — Verisk Health announced today a breakthrough initiative aimed at using the power of pooled data to improve payment accuracy in healthcare. With some of the nation’s leading healthcare payers joining as founding members, Verisk Health has built a database of cross-payer information and analytics designed to combat the estimated $300 billion that America’s healthcare system loses annually to fraud, waste, and abuse.

“Together with our founding members, Humana and Centene, we’re taking the fight against fraud, waste, and abuse to a whole new level. This initiative will turn the identification of illicit billing practices from an abstract view into an actionable one and save millions in claims dollars in the process,” said Joel Portice, president of Verisk Health.

The Verisk Health alliance represents a revolutionary step in the way healthcare dollars are processed and paid. For the first time, healthcare payers will be afforded the same comprehensive view of suspect providers and schemes that has proved so successful for the property/casualty industry.

“To date, the concept of pooling data across payers was considered too time-consuming and difficult to navigate because of the restrictive privacy laws in healthcare,” added Portice. “Because of that, we’ve spent countless hours assessing the risks of working with cross-payer pooled data and considering the opinions of multiple HIPAA attorneys and statutory and regulatory law experts to be absolutely sure we are fully compliant with existing governing mandates. The resulting alliance is one giant step forward in fraud detection and prevention.”

In addition to breakthrough analytical models and insights, the Verisk Health initiative will introduce a series of cross-payer communication tools to increase efficiency and collaboration among the various participants. And in an effort to offer continued communication and training, Verisk Health will sponsor roundtable sessions among its alliance members to facilitate further collaboration that is vital to a successful antifraud effort.

“It’s time to recognize that no one can be nearly as successful alone as we can be together,” said Robert Miromonti, vice president, Ethics and Compliance for Centene Corporation. “This is definitely the case with fraud, waste, and abuse, and that’s why we’re excited to be members of this innovative initiative. We’re confident that a cross-payer, data-driven solution will prove invaluable in the fight against fraud.”

By offering 360-degree provider views, predictive analytics, and cross-payer collaboration tools, Verisk Health is equipping antifraud leaders with the solutions necessary to effectively counter the inefficiencies in America’s healthcare system.

About Verisk Health
Verisk Health, a subsidiary of Verisk Analytics (Nasdaq:VRSK), helps organizations identify, manage, and mitigate healthcare risk to improve quality, reduce costs, and maximize profitability. Our data-driven risk assessment technologies and business decision analytics enable clients to proactively seize opportunities for improving clinical, financial, and performance results. Our solutions optimize the efficiency of key business objectives, including care management; risk identification and stratification; HEDIS compliance; benefit program measurement; fraud, waste and abuse prevention; payment accuracy; and revenue cycle management. For more information, please visit www.veriskhealth.com.

Release: Immediate

Contact:

Kristin Woodworth
kwoodworth@veriskhealth.com
781-693-3755

Ashley DePaolo
AshleyD@commcreative.com
617-763-3861