Tag Archives: healthcare fraud shield

Healthcare Fraud Shield Unveils Groundbreaking New Enhancements to RxShield™, a Pharmacy Fraud Waste & Abuse Analytics Solution

10 Nov

RxShield

Healthcare Fraud Shield (HCFS), the fastest growing Fraud, Waste and Abuse (FWA) system in healthcare today, announced the launch of the latest updates to their advanced pharmacy analytics solution. HCFS’s unique technology breakthroughs in pharmacy source data, advanced analytics and cutting edge dashboards deliver the most clear, concise and accurate indicators of drug related issues to our client network.   HCFS has fully integrated this powerful advanced RxShield™ system into every aspect of our SaaS platform including Pre-pay and Post-pay, Advanced Query and Case Management Systems, providing seamless critical pharmacy specific feedback at every stage of the FWA review process.

Steven Halper, CEO of HCFS, comments, “We are thrilled to develop this “game changing” pharmacy solution at a time when our healthcare industry is reeling from spiraling pharmaceutical costs, drug related overdoses and fraudulent medication prescriptions.  We invite interested parties to consider this as your invitation to peer into the future of pharmacy validation in a whole new way – through the powerful lens of RXShield™.”

Some of the many new advantages that RxShield™ delivers include, but is not limited to the following:

  • Incorporate unique external data elements to identify pharmacies and prescribers with state and/or federal sanctions
  • Demonstrate abusive patterns of prescription use by members
  • Morphine equivalent dosing alerts to identify overprescribing and overutilization
  • Detect prescribers providing medications outside the standard of care
  • Identify pharmacy aberrancies such as excessive use of override code
  • Detect pharmacies dispensing high volumes of brand versus generic drugs
  • Conduct cross-claim analysis between pharmacy and medical claims to identify medications without supported medical diagnoses

About Healthcare Fraud Shield

Healthcare Fraud Shield (www.hcfraudshield.com) is one of the fastest growing providers of FWA systems in the healthcare industry.  Customers who implement the FWAShield™ suite of SaaS products have realized millions of dollars in savings, have prevented certain types of fraud, and have benefited from productivity and workflow improvements. The company founders and core development team previously pioneered the automated FWA systems in the banking and finance industry, creating two of the leading solutions still in use today.  By combining this cutting-edge technology with the most knowledgeable health care fraud prevention experts, Healthcare Fraud Shield is acknowledged as the most innovative and effective solution in the market today.

Media Contact:
Tony Rademeyer
Healthcare Fraud Shield
1-888-333-8140
trademeyer@hcfraudshield.com

Healthcare Fraud Shield announces several new customer implementations and new product enhancements

21 Mar

ST. LOUIS, February 29th, 2016– Healthcare Fraud Shield, one of the fastest growing Software-as-a-Service (SaaS) Fraud, Waste and Abuse (FWA) solutions has been selected by several healthcare insurance companies to help prevent, reduce, and recover millions of dollars in wasted healthcare spending.

Financial losses in the healthcare industry are estimated by the National Health Care Anti-Fraud Association (NHCAA) to in the tens of billions of dollars. These losses have huge implications on consumers, healthcare providers, and healthcare insurance companies. In order to help prevent these FWA losses, Healthcare Fraud Shield has been developed by industry experts to be the most effective solution on the market today.

Customer implementations now include two of the top ten largest healthcare insurance companies. In addition to several other customer implementations, Healthcare Fraud Shield has been invited to participate in several industry collaboration FWA projects.

The latest enhancements, which are released quarterly to stay ahead of evolving fraud schemes, include case management updates, additional dashboards, and user experience improvements. These help customers to benefit from an integrated platform linking pre-payment and post-payment analytics, expedited decision-making, and increased querying capabilities.

“We are excited that our customers are realizing huge FWA financial return on investment results,” said Steve Halper, CEO of Healthcare Fraud Shield. “Our product development team include some of the most respected healthcare industry experts and we listen carefully to what our customers need. An indicative testament was the recent selection of our system by a customer, after their rigorous selection process of testing almost every FWA system.”

About Healthcare Fraud Shield

Healthcare Fraud Shield (www.hcfraudshield.com) is one of the fastest growing providers of FWA systems in the healthcare industry.  Customers who implement the FWAShield suite of SaaS products have realized millions of dollars in savings, have prevented certain types of fraud, and have benefited from productivity and workflow improvements. The company founders and core development team previously pioneered the automated FWA systems in the banking and finance industry, creating two of the leading solutions still in use today.  By combining this cutting edge technology with the most knowledgeable health care fraud prevention experts, Healthcare Fraud Shield is acknowledged as the most innovative and effective solution in the market today.  

Media Contact:
Richard Copeland
Healthcare Fraud Shield
1-888-333-8140
rcopeland@hcfraudshield.com

Healthcare Fraud Shield successfully achieves HITRUST CSF certification.

24 Feb

ST. LOUIS, February 23rd, 2016 – Healthcare Fraud Shield (HCFS), one of the fastest growing Software-as-a-Service (SaaS) solutions companies for Healthcare Fraud, Waste, and Abuse (FWA) detection, prevention, and recovery announced it has earned certified status for information security by the Health Information Trust (HITRUST) Alliance.

HITRUST was developed in collaboration with healthcare and information security professionals to rationalize healthcare-relevant regulations and standards into a single overarching security framework. By achieving this certification Healthcare Fraud Shield continues its commitment to meet key healthcare regulations for protecting and securing sensitive private healthcare information including the handling of Protected Health Information (PHI).

This places Healthcare Fraud Shield in an elite group of healthcare specific organizations worldwide that have earned this certification.

HITRUST™ certification for Healthcare Fraud Shield has been recognized and appreciated by Healthcare customers, especially with regards to information security, compliance, and technology decisions. Customers, who have stringent vendor approval processes with regards to information security, are able to effectively streamline review and approval processes.  “Our healthcare insurance customers all take information, data, and network security seriously. The HITRUST CSF is the gold-standard and they have been pleased with our continuous HITRUST certification,” said Steve Halper, CEO of Healthcare Fraud Shield. “With all the information security requirements, such as HIPAA, and all the challenges, such as cyber-attacks, that our customers must address, they recognize our partnership commitment to them in going above and beyond in being a trusted steward of information.”

About Healthcare Fraud Shield

Healthcare Fraud Shield (www.hcfraudshield.com) is one of the fastest growing providers of FWA systems in the healthcare industry.  Customers who implement the FWAShield™  suite of SaaS products have realized millions of dollars in savings, have prevented certain types of fraud, and have benefited from productivity and workflow improvements. The company founders and core development team previously pioneered the automated FWA systems in the banking and finance industry, creating two of the leading solutions still in use today.  By combining this cutting edge technology with the most knowledgeable health care fraud prevention experts, Healthcare Fraud Shield is acknowledged as the most innovative and effective solution in the market today.  

Media Contact:
Richard Copeland
Healthcare Fraud Shield
1-888-333-8140
rcopeland@hcfraudshield.com

Healthcare Fraud Shield Announces Improvements to Fraud, Waste and Abuse Product FWAShield

16 Sep

For Immediate Release

Healthcare Fraud Shield Announces Improvements to Fraud, Waste and Abuse Product FWAShield

St. Louis, September 15, 2015 – Healthcare Fraud Shield has added new features to its Fraud, Waste and Abuse (FWA) product FWAShield to improve FWA detection and recovery, which translates into cost savings and risk reduction for customers.  The features include: customized alert lists, link analysis, and real time access to integrated external data.  Customized alert lists allow customers to keep track of both total spend and percentage changes on specific providers, members and groups.  The integration of link analysis reveals potential relationships and connections between providers and members; it also provides key information including claim volume, dollars paid and dollars at risk for providers and members.  FWAShield customers now have the additional benefit of accessing external data in real time, which enables them to make immediate decisions.

Tony Rademeyer, Executive Vice President of Healthcare Fraud Shield, says these product improvements are part of a continuous effort to provide the most prolific data products, overlaid with superior analytics, within the most user friendly platform in terms of flexibility and customization.  “Simply stated, Healthcare Fraud Shield layers the best data analytics developed over the broadest and deepest source data to result in the most accurate findings possible.”

Healthcare Fraud Shield is one of the fastest growing providers of fraud, waste and abuse systems in the healthcare industry.  The company founders and core development team pioneered the automated fraud, waste, and abuse system space in 1995 with Appintelligence and revolutionized the Fraud Prevention market in 2005 with DataVerify, the two leading FWA systems within the mortgage and finance industry.  Leveraging their cutting edge technology gained in conquering the finance space, Healthcare Fraud Shield experts have created the consummate platform for payer, provider, and member users to maximize return on investment by minimizing medical costs associated with the fraud, waste and abuse issues challenging the healthcare industry today.

Contact:

Richard Copeland
Healthcare Fraud Shield
636-681-9302
rcopeland@hcfraudshield.com
www.hcfraudshield.com

http://www.prnewswire.com/news-releases/healthcare-fraud-shield-announces-improvements-to-fraud-waste-and-abuse-product-fwashield-300143536.html

 

OIG Releases the 2014 Work Plan

3 Feb

“The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG)Work Plan for fiscal year (FY) 2014 (Work Plan) summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year (FY) and beyond.” Click on the link below to see the full report:

http://oig.hhs.gov/reports-and-publications/archives/workplan/2014/Work-Plan-2014.pdf

Did you know Healthcare Fraud Shield is HITRUST Certified?

3 Oct
  • Healthcare Fraud Shield achieved the HITRUST certification
  • HITRUST is the Common Security Framework (CSF) utilized by 72% of U.S. hospitals and health plans for managing risk in their environment
  • The certification consists of a comprehensive audit performed by a third-party auditor regarding Healthcare Fraud Shield’s compliance with the HITRUST CSF
  • All processes and procedures related to security were audited
  • The audit Included a validation of Healthcare Fraud Shield’s controls related to handling of Protected Health Information (PHI)
  • The audit Included a review of Healthcare Fraud Shield’s production data center where our customer data is stored
  • An annual review and certification process is required to maintain HITRUST certification
  • Maintaining this certification streamlines your IT review and vendor approval process for security

www.hcfraudshield.com

Healthcare Fraud Shield To Introduce And Demo New Anti-Fraud Platform FWAShield At The NHCAA Institute For Health Care Fraud Prevention 2012 ATC

8 Nov

Healthcare Fraud Shield To Introduce And Demo New Anti-Fraud Platform FWAShield At The NHCAA Institute For Health Care Fraud Prevention 2012 ATC

CHESTERFIELD, Mo., Nov. 8th, 2012 /PRNewswire/ — Healthcare Fraud Shield, a company focused solely on fraud, waste and abuse solutions to the healthcare industry will introduce the FWAShield platform, an integrated Pre-Payment, Post-Payment, and Case Management system at the NHCAA Institute for Health Care Fraud Prevention, 2012 ATC in Anaheim, CA the week of Nov. 13th-16th 2012.

FWAShield is an advanced fraud detection platform developed by a team of veteran fraud detection experts with expertise in healthcare and advanced data analytics. FWAShield is a unique expert rules based platform which includes robust third party data sources and unique proprietary data sources never seen before in the healthcare industry.

“The FWAShield platform allows the investigator to efficiently work through claims with our expert rules engine, transparency, and user friendly interface. In addition, the platform was developed to quickly stay up to date with CPT coding changes, fraud schemes and client customizations.  The platform along with our unique data sources will bring a new dimension to recovery and increased ROI” says Mike Moseler, Chief Technology Officer at Healthcare Fraud Shield.

FWAShield’s fully integrated solution includes PreShield, PostShield and CaseShield. This combination will result in a guaranteed improved efficiency and ROI, reduced false positives, and overall reduced cost.

“Payers don’t benefit as much from ‘off the shelf’ fraud products.  Instead, they need systems that not only work smarter, but can easily conform to the needs of their organization.  The results lead to efficient detection and prevention of more viable FWA cases, rather than staff resources weeding through false positives” says Karen Weintraub, Executive Vice President SIU at Healthcare Fraud Shield.

Healthcare Fraud Shield will be at booth #111 at the conference to demo FWAShield.

About Healthcare Fraud Shield
Healthcare Fraud Shield offers a fully integrated Fraud, Waste and Abuse software solution platform called FWAShield.  FWAShield utilizes unique and proprietary data sources to maximize ROI and achieve superior results. Our platform is deployed utilizing a Software-as-a-Service model which allows us to quickly adopt new system enhancements and fraud analytics with minimal work for our customers. Our platform is designed to make the user experience simple, fast, and effective. FWAShield integrates distinctive algorithms and an expert rules-based methodology to reduce the excessive and unwanted false positives present in most other fraud detection software programs.  www.hcfraudshield.com

Contact: Tony Rademeyer, (636) 284-3559