Every year, billions of dollars are lost by federal, state and local governments due to Medicaid Fraud. When funds are depleted, those who need care will be unable to access it. What’s more, taxpayers’ money goes to unscrupulous medical providers, instead of going toward care for those in need. Every health care professional should be concerned about this problem and work to implement Medicaid Fraud solutions.
Medicaid Fraud Management
According to the Centers for Medicare and Medicaid Services (CMS), fraud takes many forms. The most common ones are:
- Billing for non-existent patients.
- Billing for services or medical supplies that were never provided.
- Overall billing of a provider comes to more than 24 hours in one day.
- Duplicate billing for services or medical goods that were not provided.
- All patients in a certain group receive the same services or the same medical goods on the same day.
Other fraudulent billing occurs when providers:
- Order unnecessary tests or treatments.
- Bill for a lengthy session when only a short one was provided.
- Upcoding: Which purposefully uses wrong billing codes in order to increase the fee for the actual service that was provided.
- Bill separately for services that were already billed in a global bill.
How Case Management Software Works
Our case management software is designed to help agencies manage Medicaid complaints and investigate fraud cases. s. Column Case Investigative provides health care agencies committed to detecting Medicaid Fraud the collaboration, content management and workflow automation tools they need to remediate complaints and close cases.
All medical providers should be concerned about detecting and preventing Medicaid Fraud and catching the perpetrators. This includes hospitals, medical groups and individual medical professionals.
With Column Case Investigative for Medicaid Fraud, you will be able to do the following:
Replaces paper-based case folders with secure, case-specific virtual workspaces. Users can coordinate their work and manage unstructured content such as Microsoft Office and PDF documents, HTML files, email messages, images, forms —even audio and video files to improve record, document, evidence and case management, in general.
User and group-level security allow complete audit trail and promote information sharing and fulfill your organization’s responsibility to protect privacy at all times — even when conducting a case investigation.
Powerful data quality case management tools use business rules and real-time logic to validate, cleanse and integrate data. The result? Accurate, timely and complete information that supports good decision making without compromising speed and efficiency.
When you need to find information, our case management software allows you to securely search external data such as documents, Web pages, attachments, forms, and activity logs. The search capability is performed through a Google® type search bar. You also have access to Column's powerful data visualization tool to help uncover relationships among data elements.
Built on the most powerful workflow engine used by over 80 percent of the Fortune 500 including the U.S. Department of Defense, Column Case Investigative can automate manual, time-intensive activities while ensuring security and role-based access. Workflow rules can mirror your current practices by sending notifications or information, creating or escalating assignments, requesting approvals and updating data fields. Whether you automate one process or all of them, you’ll eliminate redundant tasks, reduce errors, speed approvals and ensure compliance.
Powerful reporting and dashboard consoles provide real-time performance metrics and fully integrate with a wide variety of business intelligence solutions. The solution provides business intelligence by including a large number of standard reports and dashboards, as well as the ability to create custom reports and ad-hoc queries. If rolled-up data demands an explanation, you can easily drill down for more detail. This is an invaluable tool to use in case investigation and Medicaid Fraud management.
Column Case Investigative's Medicaid Fraud management software allows agencies to quickly determine what cases have a high solvability factor or high priority through automated solvability scoring. A must-have feature for Medicaid Fraud Control Units to help dramatically increase the number of cases that can be prosecuted or settled, and the dollars the department recovers.