Baltimore, MD, September 2, 2016 – Holly Pu, Vice President of New Product Development for Quality Health Strategies (QHS) and Health Integrity, joined Pednika White, SUR Administrator, Delaware Division of Medicaid and Medical Assistance presenting at the National Association for Medicaid Program Integrity (NAMPI) Conference in Baltimore, Maryland. Their presentation detailed the experience of utilizing Health Integrity’s data analytics software platform PLATO® as a predictive modeling solution for the State of Delaware’s Department of Health and Human Services (DHHS).
Headquartered in Easton, Maryland, Health Integrity is a wholly-owned subsidiary of QHS and Pu has been managing the PLATO® program since its inception. The company is a national leader in program integrity combatting fraud, waste, and abuse in Medicare and Medicaid programs for federal and state agencies. The Delaware project began as a 6-month test program in 2015 and was extended for a year following the successful outcome of the original project.
The state implemented an innovative solution to identify fraud, waste, and abuse which included increased oversight of Managed Care Organizations (MCO). “PLATO® uses a Proprietary Algorithm Library,” said Pu. “Algorithms were carefully selected from hundreds of algorithms in Health Integrity’s proprietary algorithm library based on the probability of identifying provider or client fraud and the expected dollar value of findings.” Millions of dollars in potentially inappropriate payments across multiple benefit types were identified in a short-term demonstration project. “Automated algorithms continuously and automatically identify potentially inappropriate payments as new data becomes available,” she continued. “Option Year 1 focuses on algorithms that have high return on investment but require minimal to no review or validation effort considering limited state review resources.”
Health Integrity describes PLATO® as a flexible, responsive platform, powered by a robust fraud rules engine. It is an integrated solution of predictive analytics and case management. The benefits for Delaware Include: dollar recovery actions; identification of potential fraud; policy enhancement; tightening of contract language; process improvement; and provider and MCO education.
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