Achieving Program Integrity for Health Care Cost Containment Operations

As explored in this paper, the SAS Fraud Framework supports a complete, modular, enterprise-level program integrity solution that helps payers prevent, detect and manage fraud, waste and abuse across all silos and lines of business. Its fully integrated components offer both top-down and bottom-up functionality for exposing hidden and risky networks. This approach gives payers enhanced detection capabilities, greater insight into case management and improved operational efficiency while decreasing overall cost of ownership. The result is highly effective, early, and even preventative detection of fraud, waste, abuse and corruption that improves operational efficiency and reduces health care costs.