S.E.T. Universal Platform
Did you know? ~30% of the knowledge workers across industries think that their IT tools at work are much worse than those that they... View Article
December 15, 2016
While Medicaid focus on mere member eligibility, the MCOs reap the benefit
The attitude, the opportunity and the environment together bolsters certain individuals to abuse the healthcare system. When it comes to ineligible beneficiaries, fraud... View Article
December 8, 2016
Doctor Shoppers? Not all of them… or are they?
Let’s begin with a story – A patient consults a physician for a particular chronic ailment; buys a controlled drug based on the physician’s... View Article
August 31, 2016
Fraud – not just confined to Providers
Medicaid, a federal–state health-financing program for low-income and medically needy individuals, is a significant expenditure for the federal government and... View Article
August 4, 2016
Beyond the Obvious
In 2012 Donald Berwick, a former head of the Centres for Medicare and Medicaid Services (CMS), and Andrew Hackbarth of... View Article
June 15, 2016
Fraud and abuse – the inconvenient truth
Things tend to go wrong if left alone. One of the most popular Murphy’s law states that Anything that can go wrong,... View Article
May 11, 2016
Can Healthcare IT leapfrog Financial Services with Web 3.0
I ‘m having a De Ja Vu ... View Article
May 3, 2016
Transforming Enterprises with Social Enterprise Technology Universal Platform
Equating today’s consumer internet to enterprise IT (B2B/B2E) is similar to comparing cheese to chalk. The consumer internet is awash with social media... View Article
March 13, 2016
Using Social Network Analysis (SNA) to spot bad actors
We all know that healthcare fraud continues to roil the industry. Mention worthy, most often only 5% of the overall... View Article
March 4, 2016
You don’t know what you don’t know
Fraud losses in government healthcare are on the rise. U.S. healthcare has the dubious distinction of the most amount of losses... View Article
January 20, 2016
Effective Screening with Provider Risk Scores
The National Health Care Anti-Fraud Association (NHCAA) estimates that financial losses due to healthcare fraud are in the tens... View Article
January 19, 2016
Intelligent Fraud Prevention Matters
Data is paramount for business From effective anti-money laundering for a bank to thwarting... View Article
November 30, 2015