An opaque system.
Because self-insured employers have little visibility into how their health benefits are managed, fraud and waste have run rampant. 4C offers companies a new level of insight and real accountability.
Pay and chase doesn't work.
Healthcare costs continue to double annually, in part, to a broken system that allows fraud and waste to be nearly unchecked. 4C found $400 million in improper payments for one of its clients.
Executives are personally liable.
Under ERISA, corporate executives may be personally liable for failing to rein in fraud, fined $100,000, and sentenced to ten years in prison. 4C helps protect employee benefits by preventing fraud.
Incentives are misaligned.
For too long, companies give control of one of its largest expenses to third parties who often have no incentives to reduce costs and are rewarded for growing "the business". 4C enhances accountability and gives control back to employers and employees.
Solution: 4C Defender
We use the latest adaptive analytics and behavioral profiling techniques to identify patterns of patient and provider behavior, and flag irregularities and questionable activity.Read more
4C was developed by respected leaders in healthcare, technology, and government who sought to tackle the epidemic of healthcare fraud and waste for self-insured employers and government programs.
It's time to think differently about managing health benefits. Costs are spiraling out of control. Programs are too opaque, even for the organizations paying the benefits. And billions of dollars that could be invested in benefits, better care and healthier employees are being lost. Here are our thoughts.
“Ten years ago, I built a TPA model applying similar claim editing and fraud detection applications that 4C brings to market. The sophistication of the analytics and technology support of the 4C platform advances the market far beyond the stellar results of those early applications.”
Scott Haas, Senior Vice President at Wells Fargo
“Only in healthcare do companies turn over responsibility for managing hundreds of millions of dollars to third parties. 4C returns transparency and control to those with the most at stake – employers and employees.”
Bill Fields, former CEO & President of Walmart Stores and 4C Board Member
“Fraud in our nation’s healthcare system is a serious problem for all Americans. It adds greatly to our healthcare costs, robbing American households of their hard-earned money. 4C’s creative new approach to eliminate the payment of fraudulent claims offers great promise in reducing healthcare costs and improving the performance of U.S. companies.”
John Snow, former U.S. Secretary of the Treasury and 4C Board Member
“4C’s first-of-its-kind approach may be the best way yet to reign in our nation’s healthcare fraud and waste epidemic.”
Dave Chase, Co-founder of Health Rosetta Institute, Author/Journalist