How NewWave Helps Fight Waste and Fraud in Medicare Claims

September 14, 2020

In 2017, Director of  Health Care for the U.S. Government Accountability Office, James Cosgrove, estimated improper claims to the Medicare Advantage program in the prior year alone amounted to 10 percent of the total, or $16.2 billion. Other credible estimates for the entire Medicare system put the number at around $60 billion of invalid claims paid annually.

When officials responsible for going after this huge pool of fraud, waste, and abuse engaged a systems integration firm to design, build, and manage the payments audit system, they turned to NewWave as we had already proven our ability to deliver problem-solving solutions to the most difficult of data management and infrastructure challenges, quickly and creatively.

It’s a scenario that has been repeated over and over during the last several years, and an illustration of why NewWave has developed into one of fastest-growing, most trusted integrators of major data systems that handle highly sensitive information.

It goes like this: NewWave steps in, stabilizes a system, makes tech recommendations and process improvements, and nails the delivery of a successful solution to meet current and future needs.

For the pre-existing data system that supported the audit of Medicare payments, NewWave recommended two parallel project tracks to improve what its predecessor had built; modernize the architecture; and develop a range of new solutions for the client.

Efficient Migration

Understanding the opportunity for new efficiencies, as well as the benefits of scalable storage and analytics power, NewWave’s client greenlighted our recommendation to prepare its system for migration to the cloud.

Typical of a successful NewWave-led migration, the first step in the process was to virtualize the agency’s on-premises server environment in preparation for the shift. Because a good deal of investment already had been made by the client in Microsoft services, Azure was selected as the cloud environment, based on technical feasibility, and cost effectiveness.

While the successful cloud migration effort was underway, NewWave also set out to redesign user interfaces and data management tools using a human-centric approach, Java coding, and open-source applications. By simplifying dashboards used by Medicare coders, we have now dramatically reduced the time it takes for the audit of payment records.

By reducing the time it takes for a human auditor to locate pertinent data in a record in order to conduct an analysis, productivity increases in direct proportion. That means a single individual can analyze far more records for irregularities or inconsistencies, enabling a larger sampling of records and a more thorough audit of whether a claimant’s bills to Medicare are legitimate.

With the system hosted in the cloud now, agencies conducting audits can access datasets as large as they need, with computational resources made available almost immediately and for as long or short a time, as necessary. It’s the type of user flexibility and economic efficiency that NewWave excels at delivering to customers based on its data infrastructure expertise.

NewWave’s approach to creating solutions that support audits using the most advanced, flexible, and scalable technologies and methodologies in the world are empowering those responsible for protecting the American taxpayer’s interests in Medicare as never before.

But our passion for fairness and accountability through powerful data analytics solutions, which drives us to make Medicare less prone to fraud, waste, and abuse, doesn’t stop here. Our proven successes in the public sector enable us to bring the same discipline and creativity to any domain.

Vignesh Rajan

Vignesh Rajan

Vice President, Engineering & Microsoft Solutions

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