ViPS Inc., a Baltimore-based provider of business intelligence solutions for healthcare and life science companies, has signed a multi-year licensing agreement with Medical Mutual, a Cleveland-based health insurance company, for the ViPS anti-fraud software, STARSentinel.STARSentinel is an early-warning detection system that surveys health plan data and evaluates claims in the light of provider claims' histories, specialty profiles and the most common, documented fraud schemes. By calling questionable patterns to management's attention, STARSentinel helps prioritize cases so the plan's financial investigations department use its resources more productively.
Medical Mutual serves more than 1.5 million people. Since 1983, the company has saved policyholders approximately $44 million through its aggressive pursuit of fraudulent claims. Medical Mutual investigates about 150 cases of possible fraud each year and often recovers $1 million or more per year in improper payments as a result of its vigilance. Brien Shanahan, Medical Mutual's director of financial investigations, says emphasis on anti- fraud activities is critically important since healthcare fraud is estimated to cost American consumers more than $100 billion annually.
"Targeting suspicious claims, and identifying possibly fraudulent billing patterns, are a key part of our effort to control costs and deliver high- quality care, affordable health insurance products," adds Shanahan. "What is particularly valuable about STARSentinel is the way it also supports provider education and helps identify improper billings that may be the result of simple errors and misunderstandings."
Source: ViPS Inc.
