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Detica NetReveal, a business division of BAE Systems Detica, has been selected by the Commonwealth of Massachusetts’ Executive Office of Health and Human Services to help combat Medicaid fraud and abuse and to provide prepayment screening of the Commonwealth’s Medicaid claims. Detica NetReveal will help MassHealth manage cases of fraud, ensure compliance and provide solutions to potential abuses. The implementation of this program will put Massachusetts in the vanguard of federal and state efforts to combat fraud and abuse, a problem estimated to cost U.S. taxpayers in excess of $100 billion per year nationally.
The NetReveal solution will integrate with Massachusetts’ Medicaid Management Information System (MMIS) and will include public and other Commonwealth data to automatically assess risk scores associated with claims. This will enable analysts to review, investigate and approve or deny claims; avoiding the need for costly `pay and chase` investigations. High risk cases can be referred for detailed social network analysis to help identify related patterns of serious organized fraud and abuse. Implementation of the NetReveal solution will be led by Dynamics Research Corporation.
Fraud and abuse related to Medicaid and Medicare is a substantial problem and identifying fraud and abuse after it has happened is difficult and expensive. Detica NetReveal provides the latest predictive analytic techniques and innovative social network analysis to accurately identify claims that would likely lead to improper payments.
Joe Friscia, President of the Americas, Detica NetReveal said:
“Medicaid fraud and abuse is top of every Medicaid Program Integrity professional’s agenda. Detica NetReveal deploys advanced predictive analytics to identify suspicious patterns of behaviour, detect fraud and drastically reduce improper payments. Our technology will ensure that Massachusetts is ahead of those abusing the system, by stopping improper payments before they are made.”
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