Healthcare Provider Fraud

Enformion for Healthcare Provider Fraud Prevention

Healthcare provider fraud can make a huge impact on government healthcare systems. Use Enformion to help root out fraud in the healthcare system.

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How Enformion Can Help Detect and Stop Fraud by Healthcare Providers

Information is the key to preventing fraudulent claims to government healthcare programs by healthcare providers.

Enformion Healthcare Provider Fraud Prevention Services

Healthcare Provider Fraud

We created the Enformion for Civil Enforcement software suite for requirements such as investigating healthcare provider fraud. With it, government officials can research data points relevant to typical provider schemes:

  • Find verification of the providers’ licensing.
  • Locate asset and debt records.
  • See US corporate and business records to investigate named subcontractors.
  • Find criminal arrests and convictions of actors within the claim or provider of interest.
  • Discover conflicts of interest among related parties.
  • Enformion’s robust person data and identity verification capabilities guard against cases of identity theft and nonexistent patients.

Healthcare Provider Enrollment Support

Enformion’s investigative tool suite provides an efficient approach to investigating the provider’s suitability for admittance to publicly-funded programs like Medicaid. Has the provider previously operated in another state? Is the provider’s business entity a stable business concern with adequate resources? Does the provider have sufficient liquidity to continue working if reimbursements slow?

Organized Claims Fraud

Teams perpetrate some frauds. Co-conspirators usually know each other, grew up together, or are related. Enformion’s friends, family, and associates for each subject profile can lead to the discovery of these connections between a beneficiary and the provider, or among several healthcare providers. The Enformion social media research capability can also discover less-formal relationships between any actors.

Deceased and Nonexistent Beneficiaries

While it’s a strangely prominent form of waste, most states make minimal effort to discover and remove deceased and nonexistent beneficiaries from social program rosters. 

For services such as capitated healthcare programs, providing health HMO insurance coverage, the wasteful cost to taxpayers can be enormous. Enformion’s identity verification and management, combined with our deceased audit services, assist government agencies with reducing both of these risks.

Determining Providers at Risk for Fraud

Certain providers may inherently be a higher risk of program integrity than others. For example, providers previously issued a citation for healthcare fraud may be more likely to perpetrate fraud again due to their knowledge of the system and an expectation of continued success.

Enformion can help determine which ones require a closer look.

Offering Secure Online Options for Healthcare Providers

Enformion’s resources are not only available to our Government customers; healthcare providers can implement many of our services.

  • Identity Management verifies the SSN, name, and address of your patient
  • Contact data for delinquent debt collections
  • Know Your Customer

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Talk with a specialist today to learn how Enformion can help to customize a solution that’s right for you.

Call us at 1-855-281-3915, or via online today.