Thomson Reuters Risk & Fraud SolutionsHelping you provide the right services, to the right people, by the right providers
Rely on us to help you prevent fraud, waste, and abuse in your program
Thomson Reuters can help your program comply with CMS Regulations regarding fraud, waste, and abuse oversight and reporting, by revealing high cost patients, unlicensed providers, outlier billing, utilization spikes and more. Leverage innovative analytics and deep proprietary and public records data to enable your team to efficiently discover potential waste and abuse risks within your programs.
Public records, from Thomson Reuters® CLEAR, are integrated throughout the entire process- ensuring agents have the most up to date and well sourced data on claimants.
Access investigation support from our Special Investigations Unit who can provide in-depth investigative reports that include behavioral, link and social network analysis.
Leverage robust ad-hoc reporting capabilities with both granular and global detail for management and executive level oversight and action.
Detect potential fraud within your program
Using risk scoring and data analytics, your team can immediately understand which providers are working appropriately within the system and which might need education and remediation. With Thomson Reuters ID Risk Analytics, your teams will receive a holistic, prioritized view into your agencies claim stack. Combining your agency data with identity verification and deep human analytical review provides an unmatched ability to detect, prevent, and investigate fraud within your program.
Analyze activities to discover ongoing waste and abuse risk
To further understand ongoing waste and abuse risk in your program, Thomson Reuters Fraud Detect, ingests your historical program data, matches it against pre-integrated third-party data sources, and then runs it through a series of procedural and prediction models to detect previously known and unknown anomalies and patterns. Prior to running client data through Fraud Detect, a source data validation process ingests program data and checks its data integrity, usability, stability, and fitness for analytics ensuring you can trust the results displayed during your analysis.
Prevent further risk within your program
From this dashboard, your agents can easily create cases and transfer the relevant data to Thomson Reuters Case Tracking, an integrated fraud, waste, and abuse tracking system. With Case Tracking, you can perform multiple functions, including referral assessment, case development, prosecution/hearing referral outcome tracking, and utilization of investigative outcome data to identify trends and best practices. Case Tracking includes the features and functions required to maximize successful case outcomes for your agency, while preventing fraud, waste, and abuse.
Request a free consultation
Understand how Thomson Reuters Risk & Fraud Solutions for Medicare & Medicaid can help you identify fraud schemes and accurately distribute benefits to families and individuals in need. Fill out the form and one of our experts will contact you to schedule a quick consultation.
Thomson Reuters is not a consumer reporting agency and none of its services or the data contained therein constitute a ‘consumer report’ as such term is defined in the Federal Fair Credit Reporting Act (FCRA), 15 U.S.C. sec. 1681 et seq. The data provided to you may not be used as a factor in consumer debt collection decisioning, establishing a consumer’s eligibility for credit, insurance, employment, government benefits, or housing, or for any other purpose authorized under the FCRA. By accessing one of our services, you agree not to use the service or data for any purpose authorized under the FCRA or in relation to taking an adverse action relating to a consumer application.