News Article

21CT takes direct aim at healthcare fraud with debut of investigative data analytics platform
Date: Aug 04, 2014
Author: Julie Crotty
Source: Company Data ( click here to go to the source)

Featured firm in this article: DeUmbra Inc of Austin, TX



21CT Torch, designed by investigators for investigators, becomes the ultimate weapon for fighting the national epidemic of Medicaid and Medicare fraud, waste, and abuse

Healthcare fraud, waste, and abuse has become an increasingly complicated problem, costing the US an estimated $80 billion per year*. Unfortunately, the legacy analytics tools currently serving the market were built to address the transaction-based problems of the past, depend on unscalable static models and simply spit out tasks at already overburdened state investigators. This ineffective model has led to further straining of state resources and forces time-strapped investigators to make sense of the data without the context needed to build strong cases. 21CT Torchâ„  takes direct aim at this antiquated model, offering up a purpose-built fraud detection analytics platform that leads beyond the lead to deliver actionable investigative findings.

Designed by investigators for investigators, Torch is built to expose the intelligence hidden within data. From one central solution, investigators generate leads; uncover evidence; discover hidden relationships; link people, places and things; and quickly build their case. No data degree required, Torch relies on human intuition, always-on analytics, and relational context to provide the full picture needed to permanently remove fraudsters from the system, recover funds, and identify means for future fraud prevention measures.

DATA ANALYTICS WITHOUT THE DATA DEGREE
"Healthcare fraud is having a staggering impact on each of us individually, our businesses, and our government institutions and it is time to rethink how we fight this epidemic," said Irene Williams, CEO, 21CT. "As I traveled from state to state to talk with the people on the front lines of this battle, the frustration is apparent. The legacy tools in place simply aren't cutting it, and fraud is reaching unprecedented levels. Learning from investigators throughout the country, we aimed to create a platform that doesn't focus on the data prowess of the user or rely solely on a potential lead scored by some algorithm, but rather rewards human curiosity, intuition, and in-field experience of a fraud investigator. Torch is the realization of this vision and today becomes the platform you turn to when you have a question, need an answer, and want to discover the full story, in order to make a lasting impact in this continuing battle against healthcare fraud, waste, and abuse."

A fully hosted and secure web-based platform, Torch aims to make data analytics accessible to all fraud investigators by automating the fusion of disparate data, advanced analytics, data visualization, and relational context to uncover actionable intelligence. Built to remove the overt complexity found in today's analytics platforms, Torch's intuitive user interface invites the investigator to search for what they know, discover what they don't, and see with clarity the behaviors and associations that spotlight healthcare fraud, waste, and abuse. Unlike other offerings that simply generate score-based leads, Torch leads beyond the lead to help investigators prioritize, collect evidence needed to build a case, and move rapidly toward action and recovery. Investigators powered by Torch:

Identify behavioral patterns that link disparate entities to a larger network or a coordinated fraud network.
Use contextual search to quickly find any pertinent data and enhance the efficiency of all investigative staff.

Automate analytics to make fast decisions and identify not only "bad" activities, but also the behavioral triggers that signal fraud, waste, and abuse.

Determine answers to the most critical questions and quickly rule out leads that don't pan out.

Nefarious behaviors are often interrelated in nonobvious ways, and these links are hidden among the data. By using interactive, intelligent Profile Pages, DataSets, and Graph Pattern Visualization, Torch enables healthcare fraud investigators to take a lead, identify the context, and rapidly build the case. Torch is the only fraud detection analytics product made to be used by all fraud investigators during every phase of their workflow, from generating new leads, managing hotline intake and examining facts, to discovering hidden relationships and building their cases. Torch was built to:

Use contextual search to quickly find pertinent data and enhance the efficiency of investigative staff.
Automate relational metrics to make fast decisions, identifying "bad" activities and behavioral triggers that signal fraud.

Go beyond just searching to determine answers to the most critical questions and quickly rule out leads that don't pan out.

Identify behavior patterns that link disparate entities to a larger network or a coordinated fraud network.
Collect the evidence that builds the case and move rapidly toward action against perpetrators.