FORT WORTH, Texas, August 27, 2024 – Today, CERIS, a CorVel Company, has announced advancements to its current Fraud, Waste, and Abuse (FWA) solutions, including earlier detection capabilities and improved behavioral analytics. These new integrations and services will expand on CERIS’ current FWA offering for customers as they navigate a complex healthcare industry and work to better manage and mitigate prevalent fraud and risk issues in today’s landscape. Through identity and behavioral analytics, scanners, dashboards, reporting, and FWA consulting, CERIS’ enhanced solutions are automating detection and errors in billing to aid payers in prevention and remediation.
The National Health Care Anti-Fraud Association (NHCAA) estimates that financial losses for healthcare organizations are in the tens of billions of dollars each year. A leader in payment integrity, CERIS works closely with providers to overcome challenges and false payment methods through its FWA products. Today’s enhancements will support the following:
- Fraud Case Analytics – SIU and Suspicious Activity Lead Services: Case data analytics will utilize client and industry data for rapid analysis and reporting through machine learning capabilities
- Fraud Scanners: A suite of data scanners will detect suspicious activity on pre- and post-pay claims offering clients lead detection for Fraud, Waste & Abuse
- Fraud Dashboard & Reporting: CERIS will offer flexible reporting options on client analysis and results through industry standard tools
- FWA Consulting: CERIS will bring its expertise in prevention, remediation, and operational efficiencies of payment processing in support of Fraud, Waste & Abuse management
“With today’s new advancements across FWA, CERIS is excited to support the entire enterprise, from workers’ compensation, government payments to group health, and beyond,” said Mark Johnson, Senior Vice President, Product Development at CERIS. “These enhancements will automate fraud, waste, and abuse detection within claims data through solutions that are completely customizable for CERIS customers. We are able to bring in disparate data sets – across medical claims and beyond –for customers who are eager and committed to preventing fraud across their organization.”
Over the past twelve months, CERIS analyzed over 1.1 billion claims, and from this set, 1.6 million of the claims were flagged as open to questioning, uncovering more than $700 million in suspicious medical billing via CERIS’ behavioral intelligence analytics solution. The results also showed that claims under $500 are a major source of fraud and often go undetected. More details can be found in CERIS’ recent case study. The study has also allowed CERIS to develop different categories of risk to help prioritize investigations for its clients.
“At CERIS, we are committed to ensuring the proper practices are followed in the healthcare industry and that payers are aware of any suspicious actors deemed unethical. That is why we are proud to announce today’s enhancements to our FWA offering,” said Debra Hamer, Director of Product Management for Healthcare Fraud, Waste, and Abuse at CERIS. “These improvements will allow our team to enable and foster responsibility for fraud protection across the healthcare industry.”
About CERIS
CERIS, a leader in both prospective and retrospective claims review and repricing, combines clinical expertise and cost containment solutions to ensure accuracy and transparency in healthcare payments. Accuracy and validation services include itemization review, DRG validation, facility repricing, contract and policy applications, review of implants and devices, and primary payer cost avoidance. Its universal chargemaster contains billions of charge items from more than 97% of the nation’s hospitals, helping to ensure the accuracy and objectivity of each claim review.
Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995
All statements included in this press release, other than statements or characterizations of historical fact, are forward-looking statements. These forward-looking statements are based on the Company’s current expectations, estimates, and projections about the Company, management’s beliefs, certain assumptions made by the Company, and events beyond the Company’s control, all of which are subject to change. Such forward-looking statements include but are not limited to, statements relating to the Company’s managed care services and the Company’s continued investment in these and other innovative technologies, and statements relating to the Company’s workers’ comp service offerings. These forward-looking statements are not guarantees of future results and are subject to risks, uncertainties, and assumptions that could cause the Company’s actual results to differ materially and adversely from those expressed in any forward-looking statement, including the risk that the impact of the COVID-19 pandemic on our business, results of operations and financial condition is greater than our initial assessment.
The risks and uncertainties referred to above include but are not limited to factors described in this press release and the Company’s filings with the Securities and Exchange Commission, including but not limited to “Risk Factors” in the Company’s Annual Report on Form 10-K for the year ended March 31, 2024, and the Company’s Quarterly Report on Form 10-Q for the quarters ended June 30, 2023, September 30, 2023, and December 31, 2023. The forward-looking statements in this press release speak only as of the date they are made. The Company undertakes no obligation to revise or update publicly any forward-looking statement for any reason.