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KePRO

Company Info

Location: Harrisburg, PA

Company: KEPRO

Industry: Healthcare

Size: Nation’s largest CMS-designated quality improvement organization and care management organization.

Data Problems: Ability to detect and mitigate Medicare fraud.

Data Solutions: Teknion designed and developed a integrated application allowing staff to quickly access information and make informed decisions on flagged cases.

Business Background

  • KePRO, a care management company, has a problem with Medicare fraud in Florida. Fraudulent claims from medical providers make up a great percentage of Medicare costs in Florida
  • “Home health care costs charged to Medicare in the Miami area have risen 20 times the national average in the past five years, prompting a federal investigation of suspected fraudulent billing.” – USA Today
  • KePRO needed to create a remote workforce application that would deliver relevant case information to the field, collect data through interviews, and synchronize remote data with a server for centralized management and reporting

kepro-image

Challenges

  • Deadline to plan and deploy application was very aggressive
  • Gathered requirements, designed, tested and deployed to end users in six (6) weeks
  • Case information used for the application was stored in a legacy data warehouse, requiring Teknion and KePRO to establish extraction processes for the necessary data

Results

  • Gathered, designed, tested, and deployed the application
  • 100% automation of all forms, increasing personnel efficiency, data quality and accuracy
  • Data synchronized between the remote application and the central server allowed nurses to perform reviews regardless of internet availability
  • Server Administrator component of application allows for efficient administration of nurses and cases. Fax files and other attachments can be added to cases
  • Assigned case data is securely synchronized to only the assigned nurse, including fax images and other related documents that might be needed in the field
 

What the client had to say

"Home health care costs charged to Medicare in the Miami area have risen 20 times the national average in the past five years, prompting a federal investigation of suspected fraudulent billing."

- USA Today