Ohio Health Plan Adds Latest Prevention and Detection Technology in Battle Against Fraud

ViPS Inc., a provider of business intelligence solutions for healthcare and life science companies, announced a multi-year licensing agreement with Medical Mutual, a health insurance company based in Ohio, for the ViPS’ anti-fraud software, STARSentinel.

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 reportedly 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.