Truven Health acquires Fortel Analytics

April 28, 2014 in Medical Technology

Truven Health Analytics has acquired Fortel Analytics, whose fraud detection technology will be deployed to comb data for suspicious patterns in healthcare insurance claims.

[See also: A stark link between breaches and fraud]

Fortel’s predictive analytics scour large data sets for statistical anomalies that are consistent with patterns of fraud and abuse. Claims are then flagged by the system for further investigation prior to payment.

By pairing these analytics capabilities with its own payment integrity tools, Truven Health will be better positioned to offer pre- and post-payment fraud prevention to its healthcare clients, officials say.

[See also: Public-private partnership to root out healthcare fraud]

“Our research shows that somewhere between $125 billion and $175 billion is spent every year on fraudulent health insurance claims in the U.S.,” said Mike Boswood, Truven Health Analytics president and CEO, in a press statement.

“We have built an enormously successful practice helping healthcare payers identify and reclaim much of those funds through our statistical modeling capabilities, and the next frontier is preventing the problem altogether,” he added.

Fortel’s technology is able to quickly apply multi-dimensional scoring model to systematically review all pre-payment claims and immediately identify high-risk claims that should be denied for payment immediately or analyzed for further intervention and resolution, officials say. Its based on an approach that was pioneered in the financial services industry and traces its roots to credit card fraud prevention.

Fortel’s fraud technologies will be integrated into Truven Health’s Payment Integrity Solutions product, which is deployed by large employers, health plans, the Centers for Medicare Medicaid Services and state Medicaid agencies.

The acquisition “will create an unequaled pre-payment enterprise offering for program integrity across the healthcare marketplace,” said Allan Klindworth, Fortel’s CEO, in a statement. “I am confident (Truven Health) will take our technology to new heights as they integrate it into their full suite of payment integrity solutions.”

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