Put an End to Costly Fraud, Waste & Abuse

Stop the destructive pattern of costly healthcare fraud, waste, and abuse by recognizing and addressing suspect claims before they are paid.

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The Problem

How much is healthcare fraud, waste, and abuse costing your business today? The answer might surprise you. Research shows that up to 1 in 10 dollars spent in healthcare is lost to fraud. The sources of fraud are not always intentional, ranging from simple mistakes in billing codes, to wasteful episodes of care, and falsified claims.

The problem is that once a claim is paid, the funds are nearly irrecoverable. In fact, the amount of recovered spend since 2009 pales in comparison to the aggregate fraud during that time. The problem must be corrected proactively, before payment is ever issued.

The Solution

It is important to remember that fraud, waste, and abuse is not a one-dimensional issue, so rectifying the problem requires a multi-dimensional answer. 4C Health Solutions immediately breaks the legacy of healthcare fraud, waste, and abuse by addressing each of its primary dimensions:

Quantify Fraud, Waste & Abuse

For the first time, 4C enables self-insured employers to identify suspect claims, and quantify their plan’s aggregate fraud, waste, and abuse.

Eliminate Bad Actors

By identifying repeat offenders, 4C provides employers the information they need to rid their networks of bad actors for good.

Preempt Fraudulent Payments

Using 4C’s active interventional analytics, employers can preempt fraudulent payments before they are made by intervening co-adjudication, pre-payment.

Proactively Address Waste

Finally, 4C addresses the unintentional aspects of fraud, waste, and abuse by empowering employers to identify and address sources of wasteful or unnecessary healthcare spend.

fraud by the numbers

By the Numbers

fraud numbers

2018 was the 9th consecutive year that civil healthcare fraud settlements topped $2 billion.

Health Payer Intelligence

fraud schemes

Over 600 defendants—including 165 doctors, nurses, and other licensed professionals — were charged with committing fraud schemes in 2018.

Health Payer Intelligence

billing numbers

According to the DoJ, $2.5 billion of the $2.8 billion recovered under the False Claims Act in 2018 can be attributed to fraud and improper claims from healthcare providers.

Health Payer Intelligence

“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

infographic totaling fraud damages

Infographic

Totaling the Damages
An Employer’s Guide to Quantifying & Eliminating Fraud, Waste & Abuse

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From Our Blog

 

May 7, 2019

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4C Health Solutions: Employer-Centered Focus on Health Care Costs Drives New Website

Twitter

"You as the business community are a sleeping giant,” said David Sandman, CEO of the New York State Health Foundation."You have so much power and you really have not flexed your muscles yet, but you can and you should..." https://t.co/JYUBwT6xOw #healthcare #costs #employer

What if it’s millennials that are best-equipped to fully consider the relationship between healthcare costs and outcomes?
Check out a millennial perspective from 4C's Jenna Hopkins. https://t.co/FPBkSV35bi

"As these money games dominate health care, patients are getting hammered with egregious medical bills and left holding the bag." #employer #healthcare #costs #transparency https://t.co/cG0E807fmc

"One in six Americans who get insurance through their jobs say they’ve had to make “difficult sacrifices” to pay for healthcare in the last year..."
#healthcare #employers #costs
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Alex Azar, Health and Human Services Secretary: “[Employers are] a more important force than the American government can be,” he said. “You drive so much of the healthcare system.” #healthcare #costs #employers #insights https://t.co/Rl0djrNAml