Pondera Solutions offers a fraud detection and investigative case management system. The platform also incorporates 3rd party data such as death records, incarceration information, social media data, and more and combines that data with advanced analytics to identify trends and fraud schemes in health plans.
The system includes several modules:
• DataResolver: Assesses the health of the plan’s data to improve analytic outcomes and reporting.
• FraudCaster: Integrates plan data with third party data and uses analytics, machine learning, and fraud algorithms to identify fraudulent program participants.
• CaseTracker: Provides investigative case management for case workflow, document tracking, and case reporting (time, dollars, etc).
The Pondera System assists with Compliance reporting and analysis of data related to Compliance plans to identify potential vulnerabilities. All information is displayed in dashboards that are configured to meet plan requirements.
Though Pondera does not facilitate the delivery of Telemed services for plan members, we can assist by bringing in our solutions to help monitor the Telemed program for fraud, waste, or abuse. For instance, we can help plans identify providers who may attempt to leverage the quick changes in policy and relaxing of requirements to take advantage of the plans and the members they service during this time of coronavirus crisis.