“In just 18 months, we eliminated more than $3 million of actual fraud.”
‍
-Director of Long-Term Care Operations

The Challenge

Our client, a leading long-term care insurance carrier, knew that while fraud, waste, and abuse could account for up to 20 percent of long-term care claims, they lacked the tools to uncover and eliminate it. “There wasn’t a way for us to verify the true hours of care that were being provided,” said their Director of Long-Term Care Operations.

To complicate matters, the client also received claims from hundreds of clients in almost as many formats. “We would accept an invoice if it were received on a cocktail napkin,” joked their director. “There was no standardization and no visibility into actual caregiver activity, making it difficult, if not impossible, to identify fraud, waste and abuse.”

‍

‍

The Solution

AssuriCare was the first to market with an electronic visit verification (EVV) solution for carriers.

“AssuriCare was innovative and its geofencing technology offered us the ability to verify caregiver activity in real-time. This was game changing for our company and gave us a new lens into information we’ve never seen.”

- Director of Long-Term Care Operations

The Result

“Using AssuriCare’s software, we discovered that fraud, waste and abuse accounted for eight percent of our total long-term care spend,” said the director. “In just 18 months, we eliminated more than $3 million of actual fraud.” She added that AssuriCare’s risk and stale case reports helped the team quickly identify fraud, waste and abuse cases that they wouldn’t have caught. “It was now easy to see the 'true' hours of care being provided.”

‍

“AssuriCare’s technology drove efficiencies in our process, giving us the peace of mind that we are identifying risk and processing claims timely and accurately.”

- Director of Long-Term Care Operations

AssuriCare also cut the carrier’s cycle time in half, from six to three days, keeping it well ahead of all state prompt pay regulations regarding claim response. “All claims now come in a standard, electronic format, making it easier for us to adjudicate,” the carrier’s director said. “Independent providers really appreciate AssuriCare, because many lacked a system to properly bill carriers,” said the director. “And since many agencies knew they needed to provide EVV, this gave them a head start on the process.”

‍