Large national Medicare Advantage plan engages Amenity for Prospective savings reviews. Amenity utilizes specialized proprietary prospective clinical and coding reviews to stop aberrant claims leakage on a prepay basis.
An Oregon Medicare managed care plan engages Amenity for full proprietary data mining and auditing services.
"Emory University To Pay $1.5 Million To Settle False Claims Act Investigation University Overbilled Medicare and Medicaid for Patients Enrolled in Clinical Trial Research at Emory’s Winship Cancer Institute ATLANTA - The United States Attorney’s Office for the Northern District of Georgia and Attorney General Sam Olens announced today they have reached a settlement with [...]
Amenity builds proprietary claim auditing life-cycle tracking system ACES. Amenity Claims Evaluation System (A.C.E.S.) tracks the life of each individual claim from the point of selection for audit through the closure of the claim review. This software allows for expedient auditing, prompt audit determination lettering, analytical reporting and instant access to all claim inventory and [...]
"California Medical Billing Company Agrees to Pay U.S. $4.6 Million to Resolve Allegations of False Claims to Federal Health Care Programs WASHINGTON – Janzen, Johnston & Rockwell Emergency Medicine Management Services Inc. (JJ&R), a provider of billing services for physicians, hospitals and other health care providers, has agreed to pay the United States $4.6 million [...]
A large national health plan outsources data mining and claims auditing to Amenity for its Medicaid managed care plans in five states.
"Federal Jury Convicts Psychologist for False Billings to Medicare/Medicaid JACKSON, TN—Lorne Allan Semrau, 64, of Jackson, Tennessee, was convicted by a federal jury on June 17, 2010, for three counts of submitting false and fraudulent claims to defraud health care benefits programs such as Medicare and Medicaid in Tennessee and Mississippi announced Lawrence J. Laurenzi, [...]
Amenity awarded a partial Cost Containment Unit outsource for a large Medicare managed care plan.
Amenity was engaged by a large national health plan contractor to support algorithm development, programming, SME and analytics in the managed Medicare, Medicaid and commercial space.
Our highly specialized Subject Matter Experts developed clinical logic and coding analytics to create a proprietary Claim Selection Engine (CSE). Amenity’s analytics are deployed to target aberrant claims for cost containment and recovery savings. We leverage plan specific provider contract language to customize analytics that provide meaningful and appropriate targets for analysis.
