Truven Health Supports Recovery of $268 Million in Unnecessary Healthcare Claims

Truven Health Supports Recovery of $268 Million in Unnecessary Healthcare Claims

<0> For Truven Health AnalyticsBrian Erni, 631-584-2200 </0>

℠, formerly the Healthcare business of Thomson Reuters, will present the results of a breakthrough payment integrity program that has led to nearly $500 million in identified fraud, waste and abuse for one innovative health plan.

The session, , will be presented at the National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference on November 15, from 8:45 AM to 10:00 AM. The conference, which is being held in Anaheim, CA, is the nation’s premier anti-fraud event, drawing 1,300 private- and public-sector healthcare professionals.

Presenters from Truven Health Analytics include Jean MacQuarrie, vice president; Mark Gillespie, senior director; and David Nelson, senior director. They will be joined by representatives from a rapidly growing Medicare Advantage health plan that provides complete coverage for hospital, professional, prescription drug, and care management services.

The team will outline the approach taken by the health plan, which utilized Truven Health’s Payment Integrity Enterprise™ solution to prevent, identify, and recover improper claims in their system. This health plan achieved total program return on investment of more than 50:1.

“Today’s health plans are operating in an unprecedented era of economic and regulatory uncertainty. To compete and thrive in this environment, they need to be able to efficiently remove fraud and abuse from the equation,” said Jon Newpol, executive vice president, Truven Health Analytics. “We are enormously proud of how we’ve supported this health plan’s success and we look forward to the opportunity to present our experience as a model for the industry.”

According to Truven Health research, approximately $125 to $175 billion is wasted each year on healthcare fraud and abuse. Despite the common myth that fraud and abuse are confined primarily to the public sector programs of Medicare and Medicaid, Truven Health estimates that 5-10 percent of payments in the private health plan market are inappropriate.

For more information on the NHCAA Annual Training Conference, please click .

For more information on Truven Health Analytics payment integrity solutions for health plans, please click .

Truven Health Analytics, formerly the Healthcare business of Thomson Reuters, delivers unbiased information, analytic tools, benchmarks, and services to the healthcare industry. Hospitals, government agencies, employers, health plans, clinicians, pharmaceutical, and medical device companies have relied on us for more than 30 years. We combine our deep clinical, financial, and healthcare management expertise with innovative technology platforms and information assets to make healthcare better by collaborating with our customers to uncover and realize opportunities for improving quality, efficiency, and outcomes. With more than 2,000 employees globally, we have major offices in Ann Arbor, Mich.; Chicago; and Denver. Advantage Suite, Micromedex, ActionOI, MarketScan, and 100 Top Hospitals are registered trademarks or trademarks of Truven Health Analytics. For more information, please visit .