For Federal/State Payors
The Medicare and Medicaid programs face fraud and abuse exposure unique to their provider eco-system. Unlike commercial payor models, the Federal and State systems operate under the Provider “honor system” some refer to as a “pay and chase” model.
With nefarious actors targeting the Federal and State Payors specifically for their model of reimbursement, Medilytix provides key analytics to defect fraud schemes in their infancy.
This early intervention allows for the savings to State and Federal programs to be exponential in limiting the impact of fraud and abuse.
Medilytix has partnered with the firm of Griffin, Durham, Tanner, Clarkson in a targeted model of detection, collection, investigation and litigation (when appropriate). This model provides Federal and State payors the ability to focus resources on those cases of fraud which rise to the level of criminal investigation, all the while never skipping a beat in early intervention. With attorneys bringing a combined experience of over 40 years of prosecutorial experience with the Department of Justice and over $1b in forfeitures the Griffin, Durham, Tanner, Clarkson team adds the ability to bring those cases of provider fraud worthy of prosecution a preliminary investigation component that, in most cases can bring charges immediately. This, combined with former Federal investigators with over 75 years of DOJ investigative experience, allows for a level of expertise unmatched in the medical vertical.