The Predictive Fraud and Abuse Analytic and Risk Management System

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1 The Predictive Fraud and Abuse Analytic and Risk Management System Empowering healthcare payers and stakeholders in preventing and recovering fraudulent healthcare payments

2 IkaIntegrity : Your real-time data-processing platform that supports ongoing fraud risk management Healthcare fraud is believed to be the second largest white-collar crime in the United States. It is often mistaken for a victimless crime but in reality, it affects everyone. Fraud causes insurance premiums to rise, and victims may be placed through unnecessary and unsafe procedures. The National Healthcare Anti-Fraud Association (NHCAA) cites an average of 3 percent (low-end) and 10 percent (high-end) of healthcare spending is lost due to fraud. That s between $67 billion and $230 billion lost each year to fraud, waste and abuse. And this number is anticipated to increase every year as healthcare costs rise.* Government Works IkaIntegrity can help you fight back. IkaIntegrity team members were pioneers in the invention and introduction of real-time transaction fraud prevention models introduced to the financial services industry in the early 1990's. IkaIntegrity can help prevent, detect and mitigate fraud abuse. IkaIntegrity provides security, data receipt, and standardization of data, processing, data storage, predictive model scoring, experimental design, optimization strategies and reporting. Using multi-dimensional capabilities, IkaIntegrity gauges the likelihood of unusual patterns of behavior including, but not limited to, three dimensions: healthcare claims, providers or beneficiary (individual or patient). Our predictive scoring model empowers you to proactively combat the onerous costs of healthcare fraud and abuse in three important ways: Prevent fraud and abuse on a pre-payment basis. Detect fraud and abuse on a post-payment basis. Mitigate fraud and abuse losses while minimiz ing impact on operations and resources. The entire system focuses on delivering value. Based on independently validated results, our customers have the opportunity to achieve a return-on-investment of up to 30:1 for every dollar spent on this innovative fraud prevention solution.

3 IkaIntegrity offers predictive modeling healthcare fraud and abuse detection on a pre-payment AND post-payment basis Healthcare fraud is rampant and can fall under many categories: non-rendered services, upcoding, unbundling, mischaracterization, unnecessary medical services, kickbacks, and routine waiver of co-payments quackery and sham cures. IkaIntegrity is a multi-dimensional, adaptive predictive modeling risk management solution that evolves to address changing patterns in fraud with minimal risk, investment and integration challenges. It was developed by Government Works: a company with extensive and proven experience in real-time prepayment predictive modeling, analytic technology and risk management. As a result,, we provide these powerful benefits: A Single Claims-And-Recovery Solution We score 100 percent of claims data to focus in on high-risk claims that should immediately be denied or analyzed further for resolution. Even after payment is issued, IkaIntegrity systematically reviews claims using multi-dimensional scoring algorithms. Comprehensive No one else has created a risk management system that captures healthcare data and healthcare financial transactions from multiple stakeholders, created a personal identification number to aggregate the information, standardize and cleanse the information, and securely store it. And no one has embedded real-time decision solutions with modularized predictive scoring models. Optimized And Customized Our predictive modeling and analytical technology platform can be customized to your particular fraud-and-abuse needs, leading to greater cost-and-recovery efficiencies down the road. Transparency On High Scores IkaIntegrity provides the ability to accurately measure results across multiple dimensions and identifies both fraud and abuse. It also identifies systemic issues and emerging trends that rules have missed. Adaptable Much like the predictive technologies used in the credit card industry, IkaIntegrity e uses advanced technology focus previously undetected or new and emerging issues that demand immediate attention and speedy response. Other fraud solutions contain rules and thresholds within rules that are easily learned and circumvented by offenders. Unlike these solutions designed primarily for identifying errors or implementing policy decisions IkaIntegrity is designed to truly predict and prevent fraud at a global level. Easy Integration Our modular technology enables easy integration into any legacy system. In addition, IkaIntegrity can be deployed at any point in the claims-processing system with minimal impact to existing hardware, software, processing operations or resources. Select ikaintegrity to view behavior across multiple geographic locations, market and payers identify fraud perpetrators and increase efficiency and measure ROI.

4 IkaIntegrity predictive modeling solution is a proven, complete, adaptive product that evolves to address changing patterns of fraud IkaIntegrity integrates one highly effective and proven fraud-and-abuse solution which provides security, data receipt, and standardization of data, processing, data storage, predictive model scoring, experimental design, optimization strategies and reporting. These solutions serve to identify, manage, and prevent fraud and abuse losses prior to payment, while at the same time minimizing the impact on providers, beneficiaries and payers. Using multi-dimensional capabilities, IkaIntegrity gauges the likelihood of unusual patterns of behavior including, but not limited to, three dimensions: healthcare claims, providers or beneficiary (individual or patient). Our predictive scoring model empowers you to proactively combat the onerous costs of healthcare fraud and abuse in three important ways: Overview and Strengths of the Product: Building predictive modeling solutions and analytical technology platforms for fraud prevention for Medicare and Medicaid. Creating secure, real-time platforms that support analytical technology deployment and on-going fraud risk management. Managing large fraud operations where effectiveness, efficiency and productivity are key goals. IkaIntegrity solution processing can be summarized in four crucial steps: First: View behavior across multiple geographic locations, markets and payers. Our proprietary software enables IkaIntegrity to take a focused look on how fraud may be playing out using targeted variables. Second: Identify fraud perpetrators. The Behavior Engine then pinpoints those who are exhibiting atypical purchase-and-transaction patterns. Third: Evolve right along with changes in fraud behavior. A high volume, speedy, real-time technological and detection scoring system dynamically learns and adjusts as fraud patterns and perpetrators change behavior, to pinpoint new fraud trends right at the beginning. Fourth: Increase efficiency and measure ROI. Through Workflow Management and Queue Management Methodology, the system enables efficient interaction with providers through multiple touch points: phone, web, and mail. A managed learning environment provides the capability to test different treatments or actions randomly on populations within the healthcare value chain to assess outcomes of various measures.

5 IkaIntegrity offers a highly configurable interface and automated analytics that enable you to effectively identify and monitor fraud and abuse like never before. On Demand Intelligence - competitive edge in technology is the key to identifying and preventing fraud. IkaIntegrity is like having an entire security team focused on reducing encountering - even eliminating futuristic healthcare fraudulent actions. The key is predictive modeling and analytic technology, which sets the highest standards for pinpointing areas associated with fraud and abuse. Innovative information technology and data security identifies and prevents fraud and abuse losses in four very crucial ways: Patent-Pending Algorithms Our state-of-the-art algorithms dramatically reduce false positives. They are far more effective than traditional approaches, such as neural networks as well as parametric, clustering, machine learning, outlier/z-scores and profiling techniques. Vigilent with Tipping Point Methodology: Identify precisely where and when a single claim, provider, beneficiary behavior or other event deviates from the norm, leading to the potential for fraud or abuse. Modified Outlier Technology Recognize and prevent fraud and abuse for each claim, provider, and beneficiary variable by using a proven and proprietary predictive evaluation process. Adaptive Fraud Management Decision Strategies Adjust to changing patterns of fraud and abuse so you do not fall behind as fraud archetypes evolve. In short, IkaIntegrity has staked out and claimed a new dimension in addressing and rectifying fraud and abuse in the healthcare environment.

6 ikaintegrity by Government Works Government Works, Inc. based in Southborough, Massachusetts, is a leading provider of innovative, comprehensive Information Technology solutions and consulting services, with a strong focus on Web-based healthcare management. Through the years, Government Works has provided products and services to a numerous U.S. federal government departments, including the Department of the Army, Department of Health and Human Services, Department of the Interior, Department of Homeland Security, Department of Justice, General Services Administration, Department of Veteran Affairs, Department of Commerce, Department of Defense, Department of Transportation, National Guard Bureau and Defense Information Systems Agency. In addition, Government Works ikaintegrity team members were pioneers in the invention and introduction of real-time transaction fraud prevention models introduced to the financial services industry in the early 1990s. As policy thought leaders, our expertise is significant in the following areas: Fraud Predictive Modeling Data Mining Healthcare Analytics Analytical Technology Operations Government Works also supports various private sector organizations through its Information Technology solutions, focusing on healthcare, program and project management, and technical services including engineering, support and vendor management. Government Works Corporate Headquarters: 257 Turnpike Road, Southborough, MA Tel: Fax: