Cost Containment

Performant's cost containment solutions focus on maximizing revenue and reducing waste in the healthcare system. Our solutions leverage Performant's proprietary program integrity capabilities that are designed to ensure compliance, efficiency and accountability for Government and Commercial payers. Our services provide the financial oversight required for accurate and appropriate healthcare payment by detecting and preventing fraud, waste and abuse. We also ensure that healthcare dollars are paid appropriately by implementing recoveries, pursuing recoupments, and identifying avenues for cost avoidance.

Our cost containment program integrity services are powered by our proprietary technologies and best-in-class recovery capabilities. With more than 16 years of experience working with State, Federal and Commercial payers, Performant has identified billions of dollars in inappropriate payments.

The statistics are staggering:
  • More than $100B in healthcare fraud
  • $48B in Medicare overpayments
  • $68B Medicaid fraud, $17B annually in billing errors

Sources:
Government Accountability Office study, 2010, 2011
National Health Care Anti-Fraud Association, 2010

Program integrity diagram

Capabilities

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  • Comprehensive audit, including:
    • Automated and semi-automated
    • Complex reviews
  • Coordination of benefits, including:
    • Third party liability
    • Medicare secondary payer
  • Pre-payment and Post-payment audits
  • Pharmacy audit
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  • Clinical based review
  • Fraud, Waste & Abuse
  • Enrollment and eligibility