Product

Fraud, Waste & Abuse

A comprehensive, web-based software application designed to identify risky providers and allow full-scope investigation and analysis.

Pulselight rapidly curates and loads all claim types (e.g., professional, institutional, pharmacy), encounters, provider enrollment, and recipient eligibility records with unmatched speed and agility. Unlock your data silos and make your data work for you so your team can deliver actionable results.

Healthcare fraud, waste and abuse is a complicated problem, costing the United States an estimated $100 billion per year. Medicaid fraud is a central part of this problem. Unfortunately, legacy analytic tools currently serving the market were built to address the transaction-based problems of the past and depend on unscalable static models that overwhelm investigators and analysts with hundreds of low-quality leads and high false positives. This ineffective model has led to increased resource costs and forces time-strapped investigators and analysts to make sense of the data without the context needed to build strong cases. Pulselight brings a modern approach to this antiquated model.

Our platform caters to the workflow of program integrity users by identifying improper payments, useless or poor quality of care, and inefficiencies. Pulselight provides all levels of users unprecedented visibility into activities to make informed critical decisions and ensure accuracy to optimize resources.

Our approach identifies previously hidden conduct, strengthens existing cases through additional evidence, and provides contextual information critical to pursuing a case.

• Reallocate internal resources to higher-value efforts
• Enables strategic decisions about when and how to proceed against certain providers (i.e., move on “obvious” actions now or observe behavior over time)
• Paradigm shift by adding intelligence-based visibility and analytics to any investigators arsenal

Root out bad providers and identify improper payments with Pulselight’s Fraud, Waste & Abuse Solution:

• Take advantage of pre-built analysis tools such as Impossible Days, Inpatient Overlap and Shared Patients
• Construct and analyze suspicious provider billing behaviors in real time
• Easy-to-understand, interactive charts that visualize the situation and clearly point to bad actors
• Discover provider networks and hidden connections using the Pulselight Graph
• Gain instant insight with provider and member Profile Pages