Fraud, Waste and AbuseHealth care reform solutions |
A significant amount of health care spending is lost to fraud, waste, and abuse. An organization has two options to combat this daunting challenge: (1) prevent fraudulent and wasteful spending before disbursement (pre-pay) and (2) pursue recovery of payments improperly disbursed (post-pay). Conditions in this space change rapidly; if you lock the front door, the fraudster will check the back door – lock the back door and the fraudster will check the windows – and so on. Given the complexity, changing dynamics, and sheer magnitude of this challenge, an organization’s strategy must be multi-dimensional, adaptable, and forward-looking.
Deloitte is prepared to apply its fraud-detection capabilities, honed in the commercial and federal investigative world and recognized globally, to help organizations implement effective solutions to help face off against this challenge. Deloitte professionals have the financial acumen, investigatory skills, advanced analytical experience, and the formal training/certification to identify waste, fraud, and abuse, develop holistic mitigation strategies, and support investigations spanning many levels of complexity and breadth. This approach effectively allows more money to be “kept in the system” for productive use.
Deloitte’s diverse team of committed professionals is prepared to address your needs in the area of fraud risk management. Our team includes fraud specialists, forensic technologists, certified public accountants and fraud examiners, data analysts, programmers, statisticians, and economists, as well as former senior law enforcement officials and agents from the FBI and other federal, state, and local government agencies.
Services
- Continuous Monitoring Technology
- Anti-Fraud Technology
- Improper Payment Services
- Forensic Accounting
- Contract Accountability
- Fraud Risk Profiling
- Inspector General Support
- Investigation Support
Tools and Methodologies
- Predictive Analytics
- Predictive Model Business Implementation Methodology (PMBIM)
- Rules-Based Detection
- Data Mining & Profiling
- Transparency PRISM
- Dynamic Process Review
- Entity Resolution
- Anti-Fraud Diagnostics
Key contacts
Pat Nigro
Director, Deloitte Financial Advisory Services LLP
Kirk Petrie
Senior Manager, Deloitte Financial Advisory Services LLP
