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Ascellon Attending Premier Health Care Fraud Conference in OKC

17 Sep

The Ascellon team is attending the National Association for Medicaid Program Integrity (NAMPI) Conference, September 16th through the 18th, in Oklahoma City. NAMPI membership is comprised of state and federal officials whose primary task is to investigate instances of fraud & abuse in the Medicaid Medical Assistance Program. NAMPI’s membership currently consists of attorneys, nurses, contractors, investigators, managed cared staff, managers, pharmacists and others.

Ascellon is giving demos of its ANSWERS fraud solution. Government agencies across the nation are faced with the crisis of having to do more with less while maintaining health care coverage to a growing population. ANSWERS® by Ascellon is a highly integrated suite of applications designed to identify specific patterns of concerns associated with fraud, waste, and abuse within the health care system.
To set up a demo for your team at this year’s NAMPI conference, please contact James Baker or call 703.303.4233.

Watch the latest video on the Ascellon Answers solution to healthcare fraud.

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Evolving From Fee for Service to Managed Care

6 Jul

As fee based Healthcare evolves into managed care, new methods of controlling costs will be a priority for government and businesses trying to avoid waste and fraud.  Fee for service and managed care present very different challenges for agencies and businesses concerned about healthcare fraud.

Added to the list of schemes like billing for services not rendered and using more lucrative clinical codes under fee for service, is the incentive to under service people who are enrolled, in order to maximize margins under managed care. Capitation fees (fixed fee for each person covered) offer different incentives for fraud. As our healthcare system transitions from fee for service to managed care, the workload will only increase for those charged with detecting fraud and the need for sophisticated detection tools will increase as well.   Ascellon is leading the way with innovative software packages designed to assist the healthcare community in saving money.

The Impact of Fraud on Taxpayers and the Government

22 Jun

The National Health Care Anti-Fraud Association estimates that up to 10% of the nation’s annual health care outlay may be lost to fraud and abuse and the government is by far the largest victim. The sheer size of the governments exposure to fraud within healthcare programs is of major concern because taxpayers foot the bill. The prevalence of consumer and provider fraud schemes requires ever more sophisticated tools to stem the tide ad lessen the impact of fraud on government and the taxpayer.

Consumer Fraud includes False Claims, medical identity theft and Physician shopping — where patients move between doctors to obtain multiple perscriptions.

Provider schemes often involve phantom billing and unbundling — charging separately for parts of a single procedure.

The sophisticated nature of even the most common fraud schemes requires continued vigilance and the development of tools that “dig below the surface” to monitor, detect, analyze and prevent fraud, waste and abuse.

New Technologies Aid in Detecting Health Care Fraud

9 Jun

Ade Adebisi, CEO Ascellon Corporation

As Government agencies are increasingly turn to new technologies in the war against fraud, waste, and abuse, advances in data mining, fraud detection and program monitoring will play a major role.

New data mining technologies allow for fraud risk assessment based on comparing data, analyzing trends and comparing problem areas. Analysts can share and compare current and historical data across units and regions to identify current and prevent future fraudulent activity.

At Ascellon, we’ve found that providing analysts access to new technologies we’ve developed, increases the speed with which fraud is detected and ultimately increases ROI in detection technology.

Our product provides for advanced program monitoring and analysis, allowing team members to simultaneously examine specific datasets related to diagnosis, payment patterns, medical providers, patients, prescriptions, and demographic and peer-to-peer comparisons.

As agencies confront challenges facing government health care, they will find that the effectiveness of new tools that take advantage of the latest in data mining and fraud detection technologies, will have improved exponentially, while their costs have dropped significantly. Ascellon is committed to fighting fraud waste and abuse; providing new, efficient tools for detecting fraud and lifting the burden from taxpayers.

Answers in the Battle Against Health Care Fraud

30 Apr

By Ade Adebisi, CEO Ascellon Corporation

As the cost of health care fraud reaches $80 billion annually, Ascellon Corporation has developed “ANSWERS” as the first line of defense against fraud, waste and abuse in the health care industry.

According to the Federal Bureau of Investigation (FBI), health care fraud costs the United States $80 billion a year.  Rising cost estimates and the Bureau’s recovery of a record $4.1 billion in taxpayer dollars in 2011, illustrate the need for companies like Ascellon to become major players in identifying fraud, waste and abuse in health care systems.

The threat to federal and state government continues to rise, as organized crime syndicates, insurance companies, and individuals attempt to bill taxpayers for billions in payments to which they are not entitled.  To date, federal and state agencies have put in place recovery and audit contractors to help identify fraud in their health care systems.  But, government agencies and their contractors are having trouble developing efficiencies that move them past the “low hanging fruit” of managed care and fee for service in detecting systemic abuse.

Ascellon “ANSWERS” provides government agencies with ways to empower the analyst and identify fraud more efficiently than ever before. The software suite is built on the Microsoft BI Platform and combines traditional approaches to data mining with improved tools that allow analysts and investigators to quickly react to emerging trends in potential fraudulent behavior.  “ANSWERS” provides a cutting edge approach to post-payment claims analysis, data mining and medical record review system and helps agencies identify and safeguard against fraud, waste and abuse more quickly and efficiently.

Please join me and Microsoft’s Executive Director for Health and Human Services Policy, Bill O’Leary as we discuss “The Fraud Battlefield in Government,” one of many discussions on the challenges facing government health care organizations as well as the cutting edge technology being used to combat fraud, waste, and abuse around the country.