Medical Mutual Health Insurance Fraud Protection

BALTIMORE, June 7 /PRNewswire/ -- ViPS, Inc., a major provider of business intelligence solutions for healthcare and life science companies, today announced a multi-year licensing agreement with Medical Mutual, the oldest and largest health insurance company based in Ohio, for the ViPS' anti-fraud software, STARSentinel(TM).

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STARSentinel is an early-warning detection system that surveys health plan data and evaluates claims in the light of provider claims' histories, specialty profiles and the most common, documented fraud schemes. By calling questionable patterns to management's attention, STARSentinel helps prioritize cases and helps the plan's Financial Investigations department use its resources with maximum productivity.



Medical Mutual serves more than 1.5 million people. Since 1983, the company has saved policyholders approximately $44 million through its aggressive pursuit of fraudulent claims. Medical Mutual investigates about 150 cases of possible fraud each year and often recovers $1 million or more per year in improper payments as a result of its vigilance. Brien Shanahan, Medical Mutual's director of Financial Investigations, said emphasis on anti- fraud activities is critically important since healthcare fraud is estimated to cost American consumers more than $100 billion annually.



"Targeting suspicious claims, and identifying possibly fraudulent billing patterns, are a key part of our effort to control costs and deliver high- quality care, affordable health insurance products," added Shanahan. "What is particularly valuable about STARSentinel is the way it also supports provider education and helps identify improper billings that may be the result of simple errors and misunderstandings."



"In the long run, controlling improper payments will improve both business results and the quality of care that is delivered," stated Jenny Morgan, president and chief executive officer at ViPS. "With a product like STARSentinel, Medical Mutual can continue its long track record of containing loss and improving performance."