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Reflective Medical can help customers improve both preventive and detective internal controls over claims payments, and thereby significantly reduce payments for fraudulent claims, through best practice assessments and implementation services. During these assessments we review organizational competencies, operations and policies. We make recommendations for improvements and assist customers with implementation. Our management consulting team is staffed by experts in audit, investigations, case preparation and management, prosecution, advanced technologies, claims processing, and health care.

The primary characteristics that differentiate Reflective Medical from all other anti-fraud contractors in the market involve bring the feasibility of adopting a zero tolerance approach to false claims within the health plan and Reflective' ability to train local officials to utilize its technology and investigate, prosecute and eliminate false claims submitters from the health plan.

All of the above is accomplished Reflective Medical's field proven management consulting capabilities. Reflective Medical does not just sell and implement software; we deliver end-to-end solutions. Reflectiv Medical's management consulting brings to its clients an end-to-end solution that is required to identify, confront and thereafter eliminate false claims generators from the provider panel within any health plan.

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Specifically:

• Our data mining technology has now been proven in two separate proof of concept efforts to have an accuracy rate of between 80% and 100% in identifying false claims generators.


• Reflective Medical then brings proven investigative techniques that it will use to upgrade local law enforcement's ability to handle complex white collar criminal activity. These techniques include forensic auditing, identity theft investigations and criminal investigative experience.


• Once false claims generators have been targeted, Reflective can build a data base that spans years to assist local law enforcement in moving quickly to indictment and plea bargain.


• Reflective Medical also has the ability to assist local prosecutors as they confront investigated false claims generators. Reflective' experience includes prosecutorial approaches along with legal theories that have been proven effective in the past at both the state and the federal court levels.


• All of the above significantly increases the return on investment that allows law enforcement to investigate and prosecute every false claims generator within a health plan. This decreased cost for policing health plans allows for a zero tolerance approach on the part of health plan administrators in the future.

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Finally, Reflective Medical has the ability to support its customers in generating a full public relations campaign on behalf of its clients to alert the public as to the dangers of identity theft. This campaign would include publishing article in the local press, interviews and meetings with members of the public in hosted seminars.

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Reflective Medicals' Systems Integration Services are required for every project to ensure that ClaimSentry is properly deployed without disrupting the existing claims payment systems or overburdening existing workloads. We use this Reflective Medical Process, a structured methodology to ensure success at each customer.

 

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Reflective Medical provides not only training for use of ClaimSentry, but also provides training regarding best practices for investigations and case preparation. Our training department includes former state and Federal investigators and prosecutors who have lead the most successful fraud recovery units in the country.