CareCentrix, Performant to Cut DME ‘Waste, Fraud, Abuse’

Home healthcare management company identifies DME as “high risk areas.”

CareCentrix, which helps manage in-home medical care between providers and payers and health plans, has partnered with Performant Financial Corp. to provide tools for identifying and decreasing waste, fraud and abuse on claims for DME.

The company said that home healthcare and DME are “known as high-risk areas for insurance abuse and error,” and cited Medicare’s figures of $11.4 billion annually wasted on in improper payments.

Carecentrix said it and the well-known CMS claims auditor would combine their home health care and cost-containment expertise to deploy specialized analytics and algorithms that will more effectively detect fraud patterns that “add significant cost to healthcare 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 healthcare 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 healthcare payers, as well as various Medicare benefits, such as DME,  prosthetics, home healthcare and hospice.

“Addressing abuse in high-risk payment areas, including DME and home healthcare, has become a growing concern among health care payers,” said Simeon Kohl, Senior Vice President of Healthcare at Performant. 

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

Technology Building Blocks for HME & CRT Providers podcast