Every year, billions of dollars are lost by federal, state, and local governments due to Medicaid Fraud. With that said, Column is addressing the healthcare investigative management process by building a world-class investigative application to help prosecute and manage Fraud and Abuse.
Medicaid Fraud Management
According to the Centers for Medicare and Medicaid Services (CMS), fraud takes many forms. The most common ones are:
- Billing for non-existent patients.
- Billing for services or medical supplies that were never provided.
- Overall billing of a provider comes to more than 24 hours in one day.
- Duplicate billing for services or medical goods that were not provided.
- All patients in a certain group receive the same services or the same medical goods on the same day.
Other fraudulent billing occurs when providers:
- Order unnecessary tests or treatments.
- Bill for a lengthy session when only a short one was provided.
- Upcoding: Which purposefully uses wrong billing codes to increase the fee for the actual service that was provided.
- Bill separately for services that were already billed in a global bill.
Our case management software is designed to help agencies manage Medicaid complaints and investigate fraud cases. Column Case Investigative provides health care agencies committed to detecting Medicaid Fraud with the collaboration, content management, and workflow automation tools they need to remediate complaints and close cases.
With Column Case Investigative for Medicaid Fraud, you will be able to do the following:
Enhance information sharing
Replaces paper-based case folders with secure, case-specific virtual workspaces. Users can coordinate their work and manage unstructured content such as Microsoft Office and PDF documents, HTML files, email messages, images, forms —even audio and video files to improve record, document, evidence and case management, in general.
Replaces paper-based case folders with secure, case-specific virtual workspaces. Users can coordinate their work and manage unstructured content such as Microsoft Office and PDF documents, HTML files, email messages, images, forms —even audio and video files to improve record, document, evidence and case management, in general.
Deploy rigorous access and audit controls
User and group-level security allow a complete audit trail and promote information sharing and fulfill your organization’s responsibility to protect privacy at all times — even when conducting a case investigation.
User and group-level security allow a complete audit trail and promote information sharing and fulfill your organization’s responsibility to protect privacy at all times — even when conducting a case investigation.
Track Penalties and Fines
Once fraud has been detected, our application helps track and collect fines and penalties.
Once fraud has been detected, our application helps track and collect fines and penalties.
Improve information access from search and data visualization options
When you need to find information, our case management software allows you to securely search external data such as documents, Web pages, attachments, forms, and activity logs. The search capability is performed through a Google® type search bar. You also have access to Column's powerful data visualization tool to help uncover relationships among data elements such as a Medicaid ID, Birthday or Address.
When you need to find information, our case management software allows you to securely search external data such as documents, Web pages, attachments, forms, and activity logs. The search capability is performed through a Google® type search bar. You also have access to Column's powerful data visualization tool to help uncover relationships among data elements such as a Medicaid ID, Birthday or Address.
Increase efficiency with electronic forms and customizable workflows
Column Case Investigative can automate manual, time-intensive activities while ensuring security and role-based access. Workflow rules can mirror your current practices by sending notifications or information, creating and escalating assignments, requesting approvals, and updating data fields. Whether you automate one process or all of them, you’ll eliminate redundant tasks, reduce errors, speed approvals, and ensure compliance.
Column Case Investigative can automate manual, time-intensive activities while ensuring security and role-based access. Workflow rules can mirror your current practices by sending notifications or information, creating and escalating assignments, requesting approvals, and updating data fields. Whether you automate one process or all of them, you’ll eliminate redundant tasks, reduce errors, speed approvals, and ensure compliance.
Access up-to-the minute data with a customizable, Web-based reporting engine
Powerful reporting and dashboard engine provides real-time performance metrics and fully integrates with a wide variety of business intelligence solutions. The solution provides business intelligence by including many standard reports and dashboards, as well as the ability to create custom reports and ad-hoc queries. If rolled-up data demands an explanation, you can easily drill down for more detail. This is an invaluable tool to use in case investigations and fraud management.
Powerful reporting and dashboard engine provides real-time performance metrics and fully integrates with a wide variety of business intelligence solutions. The solution provides business intelligence by including many standard reports and dashboards, as well as the ability to create custom reports and ad-hoc queries. If rolled-up data demands an explanation, you can easily drill down for more detail. This is an invaluable tool to use in case investigations and fraud management.
Implement prioritization in your case load for quick solvability
Column Case Investigative’ s Medicaid Fraud management software enables agencies to quickly identify cases with a high solvability factor or high priority through automated solvability scoring. A must-have feature for Medicaid Fraud Control Units to help dramatically increase the number of cases that can be prosecuted or settled, and the dollars the department recovers.
Column Case Investigative’ s Medicaid Fraud management software enables agencies to quickly identify cases with a high solvability factor or high priority through automated solvability scoring. A must-have feature for Medicaid Fraud Control Units to help dramatically increase the number of cases that can be prosecuted or settled, and the dollars the department recovers.
