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Data Solution Helps CMS Organization Combat Medicare Fraud

Kepro, the nation’s largest CMS-designated quality improvement and care management organization, had a problem with Medicare fraud in Florida. Over a five-year period, home healthcare costs charged to Medicare in the Miami area rose 20 times the national average. This same statistic that prompted a federal investigation prompted Kepro to implement a new data solution.

The Problem

Fraudulent claims from medical providers made up a great percentage of Medicare costs in Florida. Kepro needed to create a remote workforce application that would deliver relevant case information to the field, collect data through interviews, and synchronize remote data with a server for centralized management and reporting. The deadline to plan and deploy the application was very aggressive.

Solution

After a thorough, accelerated discovery phase, Resultant designed and developed an integrated application enabling staff to quickly access information and make informed decisions on flagged cases. Case information used for the application was stored in a legacy data warehouse, requiring us to establish with Kepro an extraction process for the necessary data.

Resultant gathered requirements, designed, tested, and deployed the application to end users in six weeks.

Outcomes

Full development lifecycle from discovery phase through successful launch in six weeks
100% automation of all forms, increasing personnel efficiency, data quality, and accuracy
Data synchronized between the remote application and the central server allows nurses to perform reviews regardless of internet availability
Server administrator component of application allows for efficient administration of nurses and cases
Fax files and other attachments can be added to cases
Assigned case data is securely synchronized to only the assigned nurse, including fax images and other related documents that might be needed in the field

Data Solution Helps CMS Organization Combat Medicare Fraud

The Problem

Solution

Outcomes

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Ready to challenge your thinking?

Data Solution Helps CMS Organization Combat Medicare Fraud

The Problem

Solution

Outcomes

Impact Stories

Rapidly Growing Retina Care Provider Finds a Clear View into Data

Resultant Helps Central Indiana Corporate Partnership Refine Their Mission through Data

Improve Student Retention Through Better Data Analytics

Ready to challenge your thinking?