Verite Validation and Verification Systems
Multi-Faceted Cloud-Based Block-chain Anti-Fraud Solutions
for Public and Private-Sector Health Insurance Institutions and Enterprises
Custom - Designed Biometric Anti-Fraud Systems For Health Insurance
HYBRID BIOMETRIC SOLUTIONS FOR DRAMATICALLY REDUCING ORGANIZED HEALTH INSURANCE FRAUD
We at Verite Validation and Verification Systems have collectively over 50 years of experience in both the public and private sector Health Insurance industries, specifically dealing with architecting data warehouse systems for fighting Provider and Beneficiary fraud on a day-to-day basis. Core menbers of our founding team have been instrumental in architecting the IDR (Integrated Data Repository) for CMS as well as the architecture of data warehouses for various of the Blue Cross Blue Shield Companies, Amerigroup, CareFirst, and others.
We realized that software-only solutions can only go so far in reducing fraud, and that in order to get away from a 'Pay and Chase' way of doing business it is necessary to utilize a combination of specially-designed mobile, desktop, and server-based software and databases, along with state-of-the-art proprietary hardware and encryption technologies.
Let us show your organizaton how our unique, patent-pending solutions can practically eliminate the most pervasive types of organized Health Insurance fraud.
State of the Art Data Encryption and Communication Security
The implementation of new technologies brings with it new challenges to protect sensitive data, especially data such as biometric identifiers, that once compromised can become very dangerous in the wrong hands. We are aware of the stringent governmental guidelines dealing with sensitive HIPAA Patient Data. As such, all of our systems use state of the art data encryption and secure communications protocols, to ensure that Patient or Provider data is never compromised.
Cutting Edge Technology
Our systems utilize the same cutting edge technologies developed for governmental high-security applications, tailored to the needs of the health insurance industry. Biometric readers, GPS readings, an up-to-data database of Provider location latitude and longitude coorinates, data warehousing of claims, beneficiary, and provider data, are all combined to deliver solutions that will knock out specifically-targeted forms of organized health insurance fraud with a 1-2 punch!
Benefits and Convenience For Honest Medical Service Providers
While our systems' primary purposes are to prevent Health Insurance fraud, they also bring a new level of convenience and security to honest and legitimate practitioners, by streamling the patient identification and beneficiary status process.
Gone are the days of having a dedicated employee to verify patients' identity and current coverage status with their insurance plan. Using any of the V3 systems, patient identification and insured status validation happens in under 5 seconds.
Custom-Engineered Solutions
We realize that every Health Insurance Payer organization is faced with their own individual types of fraud problems, depending on a number of factors, such as geographic member concentrations in high-fraud cities, market demographics of their insured parties and beneficiaries, the types of coverage they carry, etc.
For this reason, we will custom design a system or systems for you that narrowly targets specific types of fraud and abuse that are your main loss centers.
Please contact our Pre-Sales Engineering Department to speak with a systems architect that can help you address your needs, and taylor a system specific to reducing or eliminating the types of fraud that are costing your organization the most money.
What Types of Fraud Do You Combat?
Health Insurance Fraud has many ugly faces, and organized criminal rings are constantly coming up with new, more-sophisticated, methods of fraud that can cost tens or hundreds of millions of dollars in paid claims before being detected.
Our systems are all custom-designed to target specific types of fraud, and to prevent any payments going out that do not pass our Patent Pending multi-level pre-payment verification and screening processes.
All of our solutions use varying combinations of one or more biometric validations of the identification of both the beneficiary and the provider, GPS validation of varying timestamped events, datawarehousing of events and biometric data, and other techniques.
All of this is integrated with your existing Beneficiary, Provider, and Claims processing systems to create a previously-unrealized level of preventative fraud protection.
Show Me The ROI
Fighting Fraud Pays Off
The National Health Care Anti-Fraud Association (NHCAA) estimates that 3% of all healthcare spending – about $68 billion – is lost to fraud each year in the United States. The FBI / CDC estimate that figure could be as high as 10%, or $226 billion The rule of thumb in the private sector is an assumption of 7.5% - 10% loss due to fraud. That's a lot of tax dollars or premium money stolen, and mostly lost forever. Government statistics show that for every dollar spent on Medicare and Medicaid Fraud and Abuse prevention and detection, seven dollars is recovered through criminal prosecution. Although these numbers certainly give credence to the current programs being used, only a very small percentge of money paid for fraudulent claims is ever recovered.
By using any of the V3-Systems' Fraud Prevention methods, fraudulent claims are never paid in the first place, ending the "Pay and Chase" syndrome.