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

 

March 20, 2019

The Informed Customer is Always Right

Recent News

 

4c health new web launch

March 15, 2019

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

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"Employers continued to see moderate health benefit cost growth of 3.6% in 2018, but projections of a 4.4% hike this year would be above the consumer price index and employees' earnings growth, a new Mercer survey warns." #healthcare #employer #insights https://t.co/lCcJUtLsFj

4C Health Solutions is excited to announce the launch of its newly redesigned website. #healthcare #costs #transparency #insights #employers https://t.co/fUf32fMPoN

“Patients are becoming wiser consumers, and much more empowered consumers..." #healthcare #artificialintelligence #costs #insights https://t.co/KtzsjARvXu

Shielded payment and quality-related data reflect the misaligned incentives of the current healthcare payment ecosystem, forcing those paying for healthcare to accept the ever-rising costs. #healthcare #costs #transparency https://t.co/Bp9ekGnAtb

It’s more than your right to see your claims data, it’s your fiduciary responsibility under ERISA law. But assuring compliance in today’s complex claims ecosystem can seem an insurmountable feat—that is, until now. #transparency #costs #healthcare #ERISA https://t.co/TeN4kFdZab