We’re putting healthcare
Protect the integrity of your health plan and determine accurate pricing with the Context4 Health Plans Suite, our modular, cloud‑based technology platform.
to empower your organization
Immediate, actionable, and defensible Fraud, Waste, and Abuse (FWA) detection built by our team of certified clinical, dental, and health benefits experts.
Accurate data and cutting-edge cloud technology combine to create a proven and defensible medicare reference-based pricing (RBP) solution.
More than 100 healthcare data sets, with professional support to optimize efficiency and compliance.
Advanced medical coding software designed to expedite claim submission and minimize denials.
from our team of experts
Monitor Potential FWA: Overutilization of High-Level Codes
In our latest blog, we discuss a recent OIG report that found Medicare could have saved millions of dollars by monitoring providers who billed the highest reimbursable codes. It shows how certain code descriptions were miscounted by providers, causing higher reimbursements that weren't owed.
Mole Removal Claim Fraud Nets Jail and Fines
A recent fraud event involving a Chicagoland doctor will cost over $1 million and jail time from a mole removal scheme. The doctor submitted false claims for mole removals that were billed on multiple, separate dates of service, which allowed this doctor to receive larger reimbursements.