HEALTH CARE FRAUD ANALYTICS

Problem:

Medicaid agencies needed to adhere to federal mandates to analyze their providers for ineligible, derogatory past actions. Much of the necessary data and analysis had never been done before and was distributed across data silos, agencies and even across different organizations.

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Action:

Through a series of participatory design sessions enlisting the customer as the Medicaid SME, I led a team creating analytics which presented only the necessary information, all in one place, so that decision-makers could quickly satisfy federal law and efficiently increase compliance all at once. 

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Result:

The pilot customer stopped hundreds of ineligible providers from submitting fraudulent claims, saving the state millions of dollars. The product is now in its fourth version update, analyzes over 40% of providers in the U.S. and makes $10m in recurring revenue each year.