CareCentrix, an industry leader in making the home the center of patient care, has partnered with Performant Financial Corporation (Nasdaq: PFMT) to offer health care payers stronger mechanisms to identify and decrease waste and fraudulent insurance claims in-home health care and durable medical equipment (DME).
Home health care and DME are known as high-risk areas for insurance abuse and error, representing more than $11.4 billion in improper payments each year for Medicare alone. i Since home health and DME claims are often high-volume but low unit cost, traditional approaches to detecting fraud often fall short and identified opportunities may not be pursued. By leveraging their collective experience in home health care and cost-containment solutions, CareCentrix and Performant will deploy specialized analytics and algorithms to better detect the patterns that are often overlooked but add significant cost to health care payers.
“You only need to look at recent headlines to know that the problems of fraud, waste, and abuse are only increasing in home health care,” said John Driscoll, Chief Executive Officer of CareCentrix. “CareCentrix is committed to bending the cost curve in health care by working with payers to guide care for their members to the home. We are thrilled to expand our capabilities in identifying and decreasing waste and fraudulent insurance claims in home health care and DME, and look forward to working with Performant to stay on the cutting edge of curbing this trend for our clients.”
For more than a decade, Performant has delivered analytics, audit and recovery services to health care payers. And now, as the cost-containment and management partner to the Centers for Medicare & Medicaid Services (CMS) in the areas of DME, prosthetics, home health care and hospice, Performant has an unprecedented view of the national landscape.
“Addressing abuse in high-risk payment areas, including DME and home health care, has become a growing concern among health care payers. We are excited to leverage CareCentrix’s unmatched knowledge of home care management in pursuit of our mutual goal to curb improper payments,” said Simeon Kohl, Senior Vice President of Healthcare at Performant.
CareCentrix partners with providers and payers in the transition to value-based care with home health management solutions and services that support improved outcomes and efficient care delivery. Headquartered in Hartford, Conn., CareCentrix connects patients with the care they need at home through a national network of over 8,000 credentialed provider locations. CareCentrix provides optimal access to quality home care for more than 23 million lives by connecting providers with patients and helping them navigate the complex home care system. CareCentrix’s extensive range of services provides support and coordination for patients and their families in every step of the healing process, including home health, durable medical equipment (DME), home infusion, sleep management and care management services, which ultimately improve care transitions and reduce unnecessary readmissions and emergency room visits.