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Healthcare claims fraud, waste and abuse
CGI has been a leader in healthcare claims auditing and recovery since 1990. Our CGI ProperPay solution and services for reducing claims fraud, waste and abuse (FWA) have helped Medicare, Medicaid and commercial payers recover more than $2.5 billion in lost payments due to improper claims. We also offer anti-fraud solutions to help detect, remedy and prevent claims fraud, pre- and post-payment.
Reducing healthcare claims fraud, waste and abuse with CGI ProperPay
CGI ProperPay provides predictive analytics, workflow management, rules management and global best practices, available in the secure Microsoft Azure Cloud. Key features include:
- Advanced algorithms to predict hidden patterns and anomalies within the entire claims data universe to identify high-potential claims for recovery
- Analytics to prevent fraudulent activity and keep patients safer, allowing staff to easily identify patterns and research claims as well as audit data through a series of views and dashboards
- Security to protect health information: the Microsoft Azure Cloud meets a broad set of international and industry-specific compliance standards
- Technology to identify, stop and recover improper payments to preserve healthcare funds and revenue
The solution is configurable to an organization’s specific business rules and reimbursement methodologies.
CGI also provides expert audit services covering all provider types, focusing on payment issues with a high rate of error and yield a return on investment. Our specialized healthcare professionals bring 25+ years of experience in analyzing and auditing medical and pharmacy claims data.
Experience and expertise
- Serving as one of the four permanent Medicare Recovery audit contractor (RAC) firms, covering 7 states and 8.5 million beneficiaries in Region B
- Performing reviews and audits on behalf of Medicaid, Medicare and commercial payers
- Breadth and depth of knowledge of a variety of payment methodologies, state and federal regulations and medical policies and contracts unique to each payer
- Proven claims audit and recovery services that have been used to audit approximately 30 million covered lives by payers ranging in size from 60,000 to 9 million members