San Ramon, California (March 1, 2022) - 4L Data Intelligence announced that Clay Wilemon has been named Chief Executive Officer and Chairman. His appointment is the result of an upgrade of the company's financial, marketing and operations systems to prepare the organization for significant growth acceleration. Clay previously served as President and Chief Commercial Officer since October 2021.
Theja Birur, company Founder and Chief Technology Officer said, "Clay's experience in brand development, leadership and commercialization is key to our next phase of success. Our FWA Prevention & Recovery and Provider Intelligence & Integrity solutions have been validated across millions of claims and providers. The technology is ready for rapid expansion, and we will benefit from Clay's background of defining and launching over 500 new brands into healthcare and technology markets."
Clay Wilemon added, "The patented Integr8 AI technology platform developed by Theja and our engineering team is proven to help healthcare providers and payers, insurance companies and governments improve service quality, serve more people and lower costs by improving data, provider, payment and decision integrity. This gave our new investors confidence that the company is clearly out of the development and validation phase and ready for significant commercial growth."
Clay is founder and former CEO of DevicePharm, a strategic marketing firm that helped define and launch over 500 new healthcare and technology brands. DevicePharm was acquired by a private equity firm. In addition, Clay has been an active investor and director in healthcare, technology and artificial intelligence companies and is a partner in Visionary Ventures. He is also a member of the Board of Directors at Octane, a Southern California economic development organization that has helped early-stage Orange County tech and med-tech companies raise over $4 billion in funding in the past decade.
The 4L Data Intelligence mission is to USE THE POWER OF INTEGR8 AI TECHNOLOGY FOR GOOD by helping healthcare payers, health systems, governments and insurers deliver better services and care and reduce trillions of dollars in out of-control costs by making actionable data accessible in real-time, automating inefficient processes and preventing fraudulent, wasteful and abusive payments that drive up costs. We do this by improving integrity at four levels: data integrity, provider integrity, payment integrity and decision integrity.
For more information, visit the company website at www.4LData.com.
©2023 4L Data Intelligence, Inc . All rights reserved.
San Ramon, California (November 1, 2022) - 4L Data Intelligence™ has been awarded a group purchasing agreement in the category of Artificial Intelligence Solutions For Healthcare 2022-2025 with Premier, Inc. Effective immediately, the new agreement allows Premier members, at their discretion, to take advantage of special pricing and terms pre-negotiated by Premier for the 4L Data Intelligence Provider Intelligence & Integrity solution that includes Automated Provider Data and Integrity Management and the newly released Automated Provider Credentialing products. Both products leverage the power of patented INTEGR8 AI™ technology and the 4L Data Intelligence continuously updated database of approximately 7 million U.S. healthcare providers.
Clay Wilemon, 4L Data Intelligence CEO said, "4L Data Intelligence is excited to offer Premier members automated INTEGR8 AI-powered, cloud-based SaaS solutions that solve most of the cost, risk, and accuracy challenges of achieving and maintaining a continuously updated, single-source of provider data truth. Our Provider Data and Integrity Management product also provides near-real-time provider integrity transparency including sanctions, criminal, civil, and financial actions, as well as key relationship insights. And the company's Automated Provider Credentialing product solves many of the speed, cost, and accuracy challenges of conventional labor-dependent provider credentialing approaches.
Premier is a leading healthcare improvement company, uniting an alliance of approximately 4,400 U.S. hospitals and 250,000 other providers and organizations to transform healthcare. With integrated data and analytics, collaboratives, supply chain solutions, and consulting and other services, Premier enables better care and outcomes at a lower cost.
About 4L Data Intelligence
4L Data Intelligence™ is the Integr8 AI™ powered company focused on
helping our customers and partners deliver better healthcare, insurance and
government services at a lower cost by improving data, provider, payment and
decision integrity. We are committed to USING THE POWER OF INTEGR8 AI™
TECHNOLOGY FOR GOOD by helping healthcare payers, health systems, governments
and insurers deliver better services and care and reduce trillions of dollars in
out-of-control costs by making actionable data accessible in real-time,
automating inefficient processes and preventing fraudulent, wasteful and abusive
payments that drive up costs. For more information visit 4LData.com
©2023 4L Data Intelligence, Inc . All rights reserved.
San Ramon, California (February 28, 2023) - 4L Data Intelligence™ today announced that it has entered into a teaming agreement with global technology consulting and digital solutions and services company LTIMindtree.
As part of the agreement, 4L Data Intelligence will enable the delivery of its patented Integr8 AI™ powered artificial intelligence solutions through LTIMindtree's suite of healthcare technology solutions.
LTIMindtree will integrate the Integr8 AI™ FWA Prevention and Recovery solution into its health insurance, TPA and other claims processing solutions, enabling payers to dynamically view activities that result in excessive payments and over-payments, which go undetected by traditional rules-based, use case-based and conventional AI-based claims editing platforms. Solutions delivered through this partnership will help LTIMindtree's payer clients to accelerate automation and process improvement by improving the accuracy and integrity of provider data and reducing the time, cost and labor dependency associated with credentialing healthcare providers. Its provider-centric approach will help payers detect and prevent healthcare payment fraud, waste, and abuse by 2X to 10X, over conventional claims editing systems.
Clay Wilemon, 4L Data Intelligence, CEO, "LTIMindtree is a global leader
in developing and delivering advanced technology solutions for its customers. We
are honored that LTIMindtree recognizes the power of our Integr8 AI technology
and decided to incorporate it into future customer solutions that will reduce
out-of-control healthcare costs while improving provider and payment integrity."
Included in the teaming agreement is also the seamless integration
of 4L Data Intelligence's Integr8 Provider Intelligence and Integrity
management solution into LTIMindtree's healthcare payer and provider customer
offerings. This will include the newly released Automated Provider
Credentialing solution that eliminates approximately 70 percent of the
time and labor associated with first-time provider credentialing and makes
24/7/365 continuous provider credentialing a reality.
"We are confident that our partnership with 4L Data Intelligence
will complement our solutions offerings to the rapidly evolving healthcare
sector in the U.S, reducing the cost of care and improving outcomes, while
driving the Edge to Core experience in the value chain, said Sriram
Kumaresan, Executive Vice President, Global Markets, LTIMindtree. "The
combination of 4L Data Intelligence's Integr8 AI™ solutions and
LTIMindtree's end-to-end suite of technology and delivery solutions will allow
customers to harness the power of dynamic, AI-powered analysis to improve
healthcare FWA detection and provider credentialing, streamline critical
operations, and drive efficiency throughout the claims management and provider
data management processes."
About 4L Data Intelligence
4L Data Intelligence™ is the Integr8 AI™ powered company focused on
helping our customers and partners deliver better healthcare, insurance and
government services at a lower cost by improving data, provider, payment and
decision integrity. We are committed to USING THE POWER OF INTEGR8 AI™
TECHNOLOGY FOR GOOD by helping healthcare payers, health systems, governments
and insurers deliver better services and care and reduce trillions of dollars in
out-of-control costs by making actionable data accessible in real-time,
automating inefficient processes and preventing fraudulent, wasteful and abusive
payments that drive up costs. For more information visit 4LData.com
About LTIMindtree
LTIMindtree is a global technology consulting and digital solutions company that
enables enterprises across industries to reimagine business models, accelerate
innovation, and maximize growth by harnessing digital technologies. As a digital
transformation partner to more than 700 clients, LTIMindtree brings extensive
domain and technology expertise to help drive superior competitive
differentiation, customer experiences, and business outcomes in a converging
world. Powered by nearly 90,000 talented and entrepreneurial professionals
across more than 30 countries, LTIMindtree - a Larsen & Toubro Group company -
combines the industry-acclaimed strengths of erstwhile Larsen and Toubro
Infotech and Mindtree in solving the most complex business challenges and
delivering transformation at scale. For more information, please visit www.ltimindtree.com.
©2023 4L Data Intelligence, Inc . All rights reserved.
4L Data Intelligence™ is the Integr8 AI™ powered company focused on helping our customers and partners deliver better healthcare, insurance and government services at a lower cost by improving data, provider, payment and decision integrity. We are committed to USING THE POWER OF INTEGR8 AI™ TECHNOLOGY FOR GOOD by helping healthcare payers, health systems, governments and insurers deliver better services and care and reduce trillions of dollars in out-of-control costs. We do this by making actionable data accessible in real-time, automating inefficient processes and preventing fraudulent, wasteful, and abusive payments that drive up costs. 4L Data Intelligence is proud to be SOC 2 Type II Certified, HIPPA Compliant, and GDPR Certified. For more information visit 4LData.com.
©2023 4L Data Intelligence, Inc . All rights reserved.
SAN RAMON, CALIFORNIA - April 13, 2023 - 4L Data Intelligence™ today announced it has partnered with Innovative Health Consultants to form a new joint venture, 4L Data Intelligence Partners, under the 4L Data Intelligence™ brand. The new partnership will combine 4L Data Intelligence's™ Integr8 AI™-powered technologies with Innovative Health Consultants' deep knowledge of modern payor strategy. This partnership will accelerate market introduction of 4L Data Intelligence's automated FWA Prevention, Audit and Recovery and Provider Data & Integrity management solutions.
"By working closely with experts that understand the nuance and complexity of payor strategy, we can accelerate deployment of our FWA Prevention, Audit and Recovery solution much faster. The faster that technology is deployed, the better we can do for the U.S. healthcare system. In that spirit, we are eager to launch this new partnership with Innovative Health Consultants. By combining our proprietary, Integr8 AI-powered solutions with IHC's proven insights and consultative power, we will achieve our goal of helping healthcare payors prevent an additional $100B per year in overpayments from fraud, waste and abuse (FWA)," said Clay Wilemon, 4L Data Intelligence CEO.
"We have known for years that superior payment integrity depends on a complete and continuous analysis of provider behavior, and that identifying issues in the pre-payment phase is crucial. However, for years people were only looking at provider data, which is just the tip of iceberg. 4L Data Intelligence is taking an innovative look at what's below the water at the entire iceberg," said Harvey Mitgang, Managing Partner, Innovative Health Consultants. "Fortunately, the team at 4L Data Intelligence has built a solution capable of turning knowledge to power faster, analyzing crucial information and generating provider behavioral and relational insights that accelerate FWA value creation for payors. We look forward to contributing to the platform's growth using the knowledge and experience we've gained by working with leading payors over many years, and to using the platform's considerable power to help our clients reach new levels of success."
About 4L Data Intelligence
4L Data Intelligence™ is the Integr8 AI™ powered company focused on helping our customers and partners deliver better healthcare, insurance and government services at a lower cost by improving data, provider, payment and decision integrity. We are committed to USING THE POWER OF INTEGR8 AI™ TECHNOLOGY FOR GOOD by helping healthcare payers, health systems, governments and insurers deliver better services and care and reduce trillions of dollars in out-of-control costs. We do this by making actionable data accessible in real-time, automating inefficient processes and preventing fraudulent, wasteful and abusive payments that drive up costs. 4L Data Intelligence is proud to be SOC 2 Type II Certified, HIPPA Compliant, and GDPR Certified. For more information visit 4LData.com.
©2023 4L Data Intelligence, Inc . All rights reserved.
SAN RAMON, CA - June 26, 2023 - 4L Data Intelligence™ , a leading provider of AI-powered solutions for the healthcare industry, is thrilled to announce the appointment of David Corso as its new Chief Commercial Officer. With over 30 years of executive experience in sales operations at renowned organizations such as UnitedHealthcare, Anthem, and the BlueCross BlueShield Association, Corso brings a wealth of expertise to the company's core leadership team.
Prior to joining 4L Data, Corso spearheaded Corporate Marketing and Commercial Business Development at CDS, a subsidiary of BlueCross BlueShield of South Carolina. During his tenure, he implemented enterprise-class health IT solutions and managed service models, resulting in cost reduction, improved technical efficiency, and enhanced productivity.
"We are delighted to welcome David to the leadership team," said Clay Wilemon, CEO of 4L Data Intelligence. " His extensive background in insurance, healthcare payment integrity, provider data, and claims management will be instrumental in accelerating the delivery of our patented Integr8 AI™ powered solutions. Furthermore, David's profound understanding of fraud, waste, and abuse challenges in both commercial and government markets will enable us to efficiently implement our FWA Prevention & Recovery solution, empowering payers to prevent billions of dollars in healthcare claims overpayments that go undetected with conventional claims editing systems."
Commenting on his new role, Corso expressed his enthusiasm for the transformative potential of advanced AI and neural learning in the healthcare sector. "Assuming the position of Chief Commercial Officer at 4L Data presents an exceptional opportunity," Corso stated. "Together, we will drive innovation and revolutionize how payers and health systems navigate the intricate realm of insurance and payment integrity. Leveraging 4L's state-of-the-art Integr8 AI™ powered solutions, we have the remarkable potential to transform claims operations, streamline provider data management, and fortify our efforts in preventing fraud. Ultimately, this will lead to saving billions of dollars by minimizing overpayment while simultaneously enhancing provider metrics related to denials and appeals."
With David Corso's appointment, 4L Data Intelligence is poised to embark on a new phase of accelerated expansion and growth. The company remains committed to delivering cutting-edge AI solutions that revolutionize the healthcare industry and drive cost savings while maintaining the highest standards of integrity and efficiency.
4L Data Intelligence™ is the Integr8 AI™ powered company focused on helping our customers and partners deliver better healthcare, insurance and government services at a lower cost by improving data, provider, payment and decision integrity. We are committed to USING THE POWER OF INTEGR8 AI™ TECHNOLOGY FOR GOOD by helping healthcare payers, health systems, governments and insurers deliver better services and care and reduce trillions of dollars in out-of-control costs. We do this by making actionable data accessible in real-time, automating inefficient processes and preventing fraudulent, wasteful and abusive payments that drive up costs. 4L Data Intelligence is proud to be SOC 2 Type II Certified, HIPPA Compliant, and GDPR Certified. For more information visit 4LData.com.
©2023 4L Data Intelligence, Inc . All rights reserved.
SAN RAMON, CA - July 6, 2023 - 4L Data Intelligence™ , a leading provider of AI-powered solutions to improve healthcare data, provider, payment, and decision integrity, is pleased to announce the appointment of Maurice N. Reid, M.D., to the company's Board of Directors and as Chief Medical Advisor. In his role as Chief Medical Advisor, Dr. Reid will leverage his vast experience in provider organization management to help 4L Data intelligence improve current healthcare fraud, waste, and abuse prevention offerings for payers and develop new payment integrity solutions for provider organizations. He will also provide strategic counsel in the development of new Integr8 AI™ solutions for clinical decision integrity.
"This is great news for our company to have a highly qualified medical and business expert to serve on our board and take an active role in advising our artificial intelligence-focused development teams," said Clay Wilemon, CEO of 4L Data Intelligence. "Dr. Reid's experience as a business innovator, medical expert, clinician, and researcher, will provide key perspectives to improve payment integrity for both payers and providers. In the end, a high-integrity, frictionless healthcare payment ecosystem focused on identifying quality providers providing quality care at an excellent value is good for everyone in the healthcare system."
Dr. Reid graduated Magna Cum Laude from Howard University and was an Assistant Professor in Emergency Medicine at the University of Maryland. In 2004 he opened the first ExpressCare Urgent Care Center, which has grown to over 40 locations across four states. ExpressCare created the innovative model of meeting patients where they are, providing flexible medical care through telehealth or flexible hours, and making healthcare accessible for all.
"I am excited about how 4L Data Intelligence is uniquely positioned in the payment integrity space. Its Integr8 AI enabled solutions will undoubtedly help payors and healthcare providers lower cost and fulfill their mission to deliver exceptional care and services," said Dr. Reid.
4L Data Intelligence™ is the Integr8 AI™ powered company focused on helping our customers and partners deliver better healthcare, insurance and government services at a lower cost by improving data, provider, payment and decision integrity. We are committed to USING THE POWER OF INTEGR8 AI™ TECHNOLOGY FOR GOOD by helping healthcare payers, health systems, governments and insurers deliver better services and care and reduce trillions of dollars in out-of-control costs. We do this by making actionable data accessible in real-time, automating inefficient processes and preventing fraudulent, wasteful and abusive payments that drive up costs. 4L Data Intelligence is proud to be SOC 2 Type II Certified, HIPPA Compliant, and GDPR Certified. For more information visit 4LData.com.
©2023 4L Data Intelligence, Inc . All rights reserved.
Password: Webex@123
Thank you for your interest in the 4L Data Intelligence webinar on The Preventive Power Of Contextual Claims Analysis.
To receive a copy of the presentation used in the webinar, or If you have questions about the technology, please contact us at info@4LData.com
©2023 4L Data Intelligence, Inc . All rights reserved.
SAN RAMON, CA - July 25, 2023 - 4L Data Intelligence™ , the leader in patented AI-powered contextual claims analysis for fraud, waste, and abuse (FWA) prevention in healthcare, today announced that it is presenting at the Payment Integrity seminar series during the National Association for Medicaid Program Integrity (NAMPI) 2023 Annual Conference. The NAMPI meeting is the leading program integrity collaboration for state Medicaid agencies and will be in Scottsdale, AZ, July 30 - August 2.
"We are excited to meet with the NAMPI program integrity leaders during the annual meeting and showcase our patented Integr8 AI™ powered FWA prevention solutions. Medicaid program integrity directors are becoming more focused on using technology to improve the efficient delivery of care to beneficiaries by preventing fraudulent, wasteful, and abusive payments that take valuable resources out of the healthcare system. Our seminar will focus on ways that state Medicaid agencies can leverage patented Integr8 AI technology for both pre-payment FWA prevention and continuous, rapid post-payment audit and recovery to detect and prevent FWA in ways that were previously impossible," said Clay Wilemon, CEO of 4L Data Intelligence.
The 4L Data Intelligence seminar during the 2023 NAMPI annual conference:
Titled: The Preventive Power of Contextual Claims Analysis -
Real Time Integr8 AI Powered Provider Behavior Analysis for Increased Pre-Payment
FWA Prevention.
Tuesday, August 1 at 3:40pm
4L Data Intelligence™ is the Integr8 AI™ powered company focused on helping our customers and partners deliver better healthcare, insurance and government services at a lower cost by improving data, provider, payment and decision integrity. We are committed to USING THE POWER OF INTEGR8 AI™ TECHNOLOGY FOR GOOD by helping healthcare payers, health systems, governments and insurers deliver better services and care and reduce trillions of dollars in out-of-control costs. We do this by making actionable data accessible in real-time, automating inefficient processes and preventing fraudulent, wasteful and abusive payments that drive up costs. 4L Data Intelligence is proud to be SOC 2 Type II Certified, HIPPA Compliant, and GDPR Certified. For more information visit 4LData.com.
©2023 4L Data Intelligence, Inc . All rights reserved.
SAN RAMON, CALIFORNIA - August 1, 2023 - 4L Data Intelligence™ , a leading provider of patented AI-powered solutions for the healthcare industry, today announced a partnership with Hospice Dynamix, a predictive analytics software platform from Diversified Health Technologies (DHT). This collaboration supports hospice agencies with patent-pending AI technology to forecast Medicare revenue, automate the Medicare cap projection for every open cap year, identify future compliance risks, and maximize census opportunities by enabling continuous and highly accurate predictive lengths of stay.
"4L Data Intelligence's knowledge and expertise gained from the development of Integr8 AI™, enabled us to partner with Hospice Dynamics to develop a sophisticated real-time predictive patent-pending technology for patient length of service that has proven to be highly accurate," said Theja Birur, Chief Technology Officer and Founder, 4L Data Intelligence.
This collaboration includes the seamless integration of 4L Data Intelligence's™ Integr8 AI™-powered platform and real-time EMR data to accurately designate a Predictive Length of Stay (PLOS) for every patient from admission through the end-of-life. The platform's database continuously learns through every patient interaction and documentation within the EMR. Through structured and unstructured machine learning technology, the more data the algorithm obtains, the more intelligent and accurate it becomes.
"Collaborating with 4L Data Intelligence to develop our platform has been a transformative experience, playing a significant role in our early success. Drawing inspiration from their patented core technology platform, we embarked on a journey to create a groundbreaking application tailored specifically for the hospice industry-a product that has never been available until now," said Terry Swatley, Chief Executive Officer, Hospice Dynamix. "By expressing our vision to 4L Data Intelligence, they dedicated their team to developing an extremely user-friendly software, combining visual simplicity with remarkable technical complexity. The result is a cutting-edge solution that has exceeded all expectations, and we are proud to consider them true partners who share our vision for the future."
4L Data Intelligence™ is the Integr8 AI™ powered company focused on helping our customers and partners deliver better healthcare, insurance and government services at a lower cost by improving data, provider, payment and decision integrity. We are committed to USING THE POWER OF INTEGR8 AI™ TECHNOLOGY FOR GOOD by helping healthcare payers, health systems, governments and insurers deliver better services and care and reduce trillions of dollars in out-of-control costs. We do this by making actionable data accessible in real-time, automating inefficient processes and preventing fraudulent, wasteful and abusive payments that drive up costs. 4L Data Intelligence is proud to be SOC 2 Type II Certified, HIPPA Compliant, and GDPR Certified. For more information visit 4LData.com.
©2023 4L Data Intelligence, Inc . All rights reserved.
© 2023 4L Data Intelligence . All rights reserved.
A 2021 4L Data Intelligence analysis of over four (4) million workers compensation claims paid showed that 19,612 providers out of a network of 86,000 submitted fraudulent claims totaling about 10% of all claims paid during the prior year. This study was conducted retrospectively using 2020 claims and network provider data for a regional workers compensation payer that paid about $107 million in fraudulent, wasteful or abusive claims on approximately $1.17 billion in total payments.
4L Data Intelligence deployed our Provider Intelligence & Integrity and FWA Prevention & Recovery solutions to retrospectively evaluate the integrity of previously paid claims, provide automated support data for recovery and increase real-time, pre-adjudication FWA prevention on future claims. Each of the 4L Data Intelligence solutions used in this analysis are powered by our patented Integr8 AI technology platform.
The findings in this regional workers' compensation study were similar to other analyses performed with the patented Integr8 AI technology platform. Most of the FWA activity identified retrospectively could have been detected and prevented in real-time using 4L Data Intelligence solutions on a continuous basis.
The first set of preventable FWA findings in this analysis were related to the provider network itself. Almost 23 percent (22.8%) of providers were flagged for some level of FWA activity. Twenty-two (22) providers were practicing with OIG, SAM or other health sanctions and should not have been in this or any other provider network. Numerous providers were practicing with multiple tax ID numbers and hundreds of others had problematic collusion maps noting high-risk relationships with DME providers, pharmacies, or other healthcare professionals. All of these providers could have been identified upfront and eliminated from the network before they were able to commit fraudulent, wasteful, or abusive actions with our Provider Intelligence & Integrity solution insights around providers' demographics, status, relationships, and behaviors. And this same solution performs continuous integrity monitoring to identify providers with integrity risks on a daily basis.
The second set of preventable FWA findings center around coding and other detectable and preventable behavioral 'red flag' anomalies. Common findings included: 1) suspicious drug prescriptions with specific CPT codes, 2) outlier procedures associated with a particular ICD code or provider type and 3) procedures billed outside of evidence-based guidelines. All of these FWA-related anomalies and more are detectable and preventable in real time with Integr8 AI continuous surveillance that enables literally every claim to be audited against millions of complex combinations of CPT and ICD-10 codes and payer guidelines as well as against individual and collective provider behaviors and relationships.
The 4L Data Intelligence FWA Prevention & Recovery solution used in this analysis, proved to provide immediate and detailed intelligence for quantifying and documenting FWA activity by provider. Think of it as an FWA case file at the press-of-a-button.
This enables recovery efforts to begin quickly and equips program integrity units and collectors with deep provider-specific data to align recovery efforts as closely as possible with the action, creating a very favorable scenario for collection.
This analysis demonstrated a number of macro-actions that the payer could take to mitigate future FWA risk. These steps included: 1) extract rendering provider information from PDF images, 2) manage invalid or missing data problems by back-walking based on known attributes, 3) improving the plan design and 4) improving formulary design.
The workers compensation payer study demonstrated that detecting and preventing FWA claims real-time BEFORE the claims are paid, can literally save payers millions of dollars each year in the of over-payment and collection costs.
It also proved that the 4L Data Intelligence Provider Intelligence & Integrity solution and the FWA Prevention & Recovery solution are powerful tools for recovering FWA over-payments, but also in detecting and preventing the cost, time, and manpower burden of recovering fraudulent payments.
To schedule a free Provider Integrity Scan or a FWA Prevention data scan, contact info@4LData.com
©2023 4L Data Intelligence, Inc . All rights reserved.
Surfers talk a lot about sets, groups of waves that keep coming one behind the other. While that may be a surfer's dream, the continuous cadence of telehealth fraud, waste and abuse stories is looking more like sets of tsunamis coming one after the other.
The dollar amounts of charges brought by the U.S. Department of Justice for telehealth and telemedicine fraud are staggering. Indictments for $4.5 billion and $1.2 billion are just the tip of the iceberg in a telemedicine market that is growing by 26.5 percent per year and expected to reach $475 billion by 2026. It's a big market with a big fraud, waste and abuse problem.
When examining some of the telehealth or telemedicine indictments a few common characteristics scream off the page. Relationships between dishonest doctors, pharmacies, labs and equipment or supplies providers are endemic in almost every case. In short, collusion between bad actors is part of each major fraud case.
The other common characteristic is that it does not require very many fraudulent providers to do a lot of damage. In a Florida telehealth fraud case announced May 3, 2021, the Department of Justice charged only three men in a $47 million healthcare fraud, kickback and money laundering scheme. In the $4.5 billion case referenced above, 86 providers were charged. And the $1.2 billion case involved only 24 people. Those are all very tightknit groups of providers united to engage in telehealth fraud.
Healthcare payers including government agencies, private insurers and self-funded employers are all asking the same question, "How can we detect bad actors BEFORE they have the opportunity to commit fraud?. The answer lies in using advanced artificial intelligence technology to connect-the-dots between structured and unstructured data from related and unrelated sources.
4L Data Intelligence was recently awarded a core technology patent for our Integr8 AI data intelligence platform that powers a machine-learning model trained using representations of a set of resource requests and authorization determinations to identify and adjudicate behaviors and transactions that are representative, or predictive of operational threats. In simple language, our 4L Data Intelligence Provider Intelligence & Integrity solution, powered by Integr8 AI, can be used to identify problem providers, relationships and behaviors in real-time. Here is how it works.
The 4L Data Intelligence Provider Intelligence & Integrity solution, powered by Integr8 AI uses provider data, payer data, public data and our own proprietary database of 7 million NPIs to immediately and continuously detect problematic activity in any provider network. The immediate output is detection of unauthorized providers, fraudulent providers operating under aliases, potentially fraudulent providers and potential collusion and relationships that point to fraudulent intent. And, because fraud and fraudulent providers are dynamic, the 4L Data Intelligence Provider Intelligence & Integrity solution, powered by Integr8 AI provides continuous surveillance to detect changes in provider demographics, status, behaviors and relationships that are indicators of new fraudulent behaviors.
Immediately and continuously identifying potentially fraudulent providers is one-half of the solution. The other half is detecting potentially fraudulent claims BEFORE they are paid.
4L Data Intelligence FWA Prevention & Recovery solution, powered by Integr8 AI reduces healthcare fraud waste and abuse by automating real-time financial, clinical and behavioral insights that help detect, prevent and recover fraudulent claims payments pre-adjudication. The power of Integr8 AI automated machine learning literally enables every claim to be analyzed with millions of combinations of CPT, ICD-10 and other code data along with payer guidelines and the provider network data.
This powerful fraud-fighting solution is on 24/7 empowering payers to stay ahead of fraudulent providers and reduce the amount of FWA leakage that gets through the system.
4L Data Intelligence is committed to providing the data insights to help healthcare payers immediately and continuously reduce risks to improve clinical and financial performance. Our Integr8 AI powered solutions provide a much-needed technology to keep the telehealth and telemedicine markets clean and healthy.
For more information about the 4L Data Intelligence solutions discussed in this story, please contact us at info@4LData.com
©2023 4L Data Intelligence, Inc . All rights reserved.
The fraud, waste and abuse (FWA) cases and convictions being prosecuted by the Department of Justice point to the rising sophistication and negative impact a single provider, or small group of providers, can have on the healthcare system. The recent conviction of a physician known as the 'Fountain of Youth' doctor is the latest example of fraudulent activity that is now detectable and preventable using the 4L Data Intelligence patented Integr8 AI technology platform based on real-time and continuous machine and deep learning.
A Fox Chapel, PA cardiologist was sentenced to six and one-half years in prison on August 5, 2021 for his role in a fraud scheme involving more than $13 million in false insurance claims, according to the Pittsburgh Post-Gazette.1 The fraudulent behavior occurred between 2008 and 2013 and included claims submitted to private health insurance companies as well as government insurance programs for an outpatient treatment called External Counter Pulsation.
These same common fraud characteristics can now be detected and prevented...
Dr. Samirkumar J. Shah's was a textbook for how providers have been able to commit fraud in the past. These same common fraud characteristics can now be detected and prevented BEFORE fraudulent claims are paid. When you examine the characteristics of Dr. Shah's fraudulent behaviors you see the following behaviors that are common in fraud cases:
So, what's the answer to detecting and preventing healthcare fraud like that committed by Dr. Shah? The 4L Data Intelligence FWA Prevention & Recovery solution, powered by Integr8 AI reduces healthcare fraud, waste and abuse (FWA) by automating real-time financial, clinical and behavioral data insights that help detect, prevent and recover fraudulent claim payments.
The blatant anomalies in his claims would have been identified in near real-time using Integr8 AI .
The key to stopping fraud before payments are made is detecting anomalies in relationships, behaviors and outcomes in a way that immediately and continuously reduces risk. Automated structured and un-structured machine-learning empowers 24/7 surveillance of financial and clinical claims data and interrogates every claim against millions of data points including ICD-10 codes, CPT codes, payer guidelines, collusion maps, patterns and relationships with other providers. More importantly, this technology interrogates each provider's behaviors and relationships around a claim and in relationship to other providers across all claims to identify FWA patterns and trends that help to identify FWA risk before it becomes a big problem.
In addition, the 4L Data Intelligence proprietary database of 7 million providers adds another powerful layer of financial and demographic sophistication to this surveillance. In doctor Shah's case, the blatant anomalies in his claims would have been identified in near real-time using the Integr8 AI artificial intelligence technology platform.
FBI Special Agent in Charge, Robert Jones said, "Health care fraud is a fundamental problem that impacts every American. It takes critical resources from our health care system and increases health care costs for everyone."
My work in both the Canadian and American healthcare systems showed me the extent to which care quality and quantity are compromised because of fraudulent actors. Our initial commercial deployment of the 4L Data Intelligence FWA Prevention & Recovery solution, powered by Integr8 AI showed us that this fraud, waste and abuse involves a range of 1.5 to 20 percent of providers depending on the network.
Most fraudsters' relationships, collusions and behaviors are generally the same, and they are now detectable in real-time. That is why I was motivated to build the Integr8 AI artificial intelligence platform. Healthcare needs this type of technology to fix what is estimated to be a $700 billion problem in the United States.
1 Torsten Ove, Pittsburgh Post-Gazette, August 5, 2021For more information about the 4L Data Intelligence solutions discussed in this story, please contact us at info@4LData.com
©2023 4L Data Intelligence, Inc . All rights reserved.
Clay Wilemon, CEO and Chairman of 4L Data Intelligence™ that helps healthcare providers and payers, insurance companies and governments improve service quality, serve more people and lower costs by improving data, provider, payment and decision integrity. Using the power of patented INTEGR8 AI™ technology for good, his company equips their customers and partners to deliver better services and care and reduce trillions of dollars in out-of-control costs by making actionable data accessible in real-time, automating inefficient processes and preventing fraudulent, wasteful and abusive payments that drive up costs. He speaks on an array of topics. Excerpts:
Citing two primary needs in the healthcare market that led to 4L Data Intelligence™ being formed, Clay Wilemon notes that these needs were first identified by their Chief Technology Officer and Founder, Theja Birur during her work in U.S. and Canadian government healthcare agencies and with a leading global data intelligence firm.
First, the entire landscape of managing provider data for health systems and health plans, TPAs, PPOs and other entities is estimated to be a $4B problem. Provider data is chronically inaccurate, provider integrity is not transparent and provider credentialing is slow, costly and labor intensive, observes Clay. "4L Data Intelligence™ leverages the power of our patented Integr8 AI™ technology and our continuously updated 7M NPI provider database to immediately clean provider data, keep it clean and accurate, create continuous provider integrity transparency and automate the credentialing process to improve accuracy, reduce time and lower cost."
Secondly, healthcare fraud, waste and abuse (FWA) are rampant. Adds this technology enthusiast, "FWA is estimated to be a $700B problem in the United States for health plans, Medicaid and Medicare programs and other payers. Current technology cannot see
the FWA problem at scale or in real-time because it is claims-centric." Using the provider-centric 4L Data Intelligence™ FWA Prevention & Recovery solution, powered by patented Integr8 AI™ technology, healthcare payers can detect and prevent FWA at a rate of 2X to 10X higher than with conventional rules-based or use-case-based claims editing systems. Best of all, this happens in real-time before claims are paid, he adds.
Clay moots for a technology that intends to make healthcare easier, more accurate and lower overall cost. "The pandemic accelerated a lot of new technologies into the market such as telehealth that accomplishes all three. However, the pandemic also exposed the cost, accuracy and speed challenges of many manual systems that health systems and payers count on every day to manage providers, make care decisions and make payments." He observes that the explosion of telehealth created a parallel explosion in telehealth fraud, waste and abuse. The key is improving data integrity, provider integrity, payment integrity and decision integrity while making all these areas more accurate and reducing cost. 4L Data Intelligence™ addresses all four levels of integrity performance while immediately and continuously improving accuracy and reducing cost.
Integr8 AI™ is the firm's patented core technology platform that automates and aggregates real-time intelligence around healthcare provider and customer data, behaviors, patterns, relationships, trends, decisions, content and transactions to improve data, provider, decision and payment integrity. "This capability, which has seven proprietary technology features, is what powers the ability to aggregate large volumes of disparate data and identify trends, patterns, outliers, relationships and behaviors that are indicators of threats ranging from payment fraud to end-of-life indicators and data inaccuracies."
4L Data Intelligence™ has four core healthcare solutions: 1) Provider Intelligence & Integrity, 2) FWA Prevention & Recovery, 3) Catastrophic Care Intelligence and 4) Revenue Intelligence & Integrity.
4L Data Intelligence™ core internal values are built on four simple concepts like honesty, respect, speed and focus. "Our K.I.N.D. pledge to customers and partners is to develop and deliver Inetegr8 AI™ powered solutions that improve data, provider, payment and decision integrity in a way that is helpful in a holistic way. I am a company, brand and team builder who is fortunate to build on the vision of our Chief Technology Officer and Founder, Theja Birur. Theja had a vision to develop an AI-powered, automated and intelligent technology platform that would solve the challenge of healthcare fraud, waste and abuse to reduce cost and improve access to healthcare for more people. We are executing her vision."
"As a serial entrepreneur, I have had failures and successes. You learn from both. Some fear of failure is healthy; you need to fear the dumb things you can do to kill a company while retaining the fearlessness to pursue the game-changing things you can do to improve the lives of your customers, their customers and your team members," he signs off.
©2023 4L Data Intelligence, Inc . All rights reserved.
Welcome to 4L Data ("us", "we", or "our") operates http://www.4lData.com (hereinafter referred to as "Service").
Our Privacy Policy governs your visit to http://www.4LData.com, and explains how we collect, safeguard and disclose information that results from your use of our Service.
We use your data to provide and improve Service. By using Service, you agree to the collection and use of information in accordance with this policy. Unless otherwise defined in this Privacy Policy, the terms used in this Privacy Policy have the same meanings as in our Terms and Conditions.
Our Terms and Conditions ("Terms") govern all use of our Service and together with the Privacy Policy constitutes your agreement with us ("agreement").
SERVICE means the http://www.4LData.com website operated by 4L Data Intelligence
PERSONAL DATA means data about a living individual who can be identified from those data (or from those and other information either in our possession or likely to come into our possession).
USAGE DATA is data collected automatically either generated by the use of Service or from Service infrastructure itself (for example, the duration of a page visit).
COOKIES are small files stored on your device (computer or mobile device).
DATA CONTROLLER means a natural or legal person who (either alone or jointly or in common with other persons) determines the purposes for which and the manner in which any personal data are, or are to be, processed. For the purpose of this Privacy Policy, we are a Data Controller of your data.
DATA PROCESSORS (OR SERVICE PROVIDERS) means any natural or legal person who processes the data on behalf of the Data Controller. We may use the services of various Service Providers in order to process your data more effectively.
DATA SUBJECT is any living individual who is the subject of Personal Data.
THE USER is the individual using our Service. The User corresponds to the Data Subject, who is the subject of Personal Data.
We collect several different types of information for various purposes to provide and improve our Service to you.
Personal Data While using our Service, we may ask you to provide us with certain personally identifiable information that can be used to contact or identify you ("Personal Data"). Personally identifiable information may include, but is not limited to:
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We may also collect information that your browser sends whenever you visit our Service or when you access Service by or through a mobile device ("Usage Data").
This Usage Data may include information such as your computer's Internet Protocol address (e.g. IP address), browser type, browser version, the pages of our Service that you visit, the time and date of your visit, the time spent on those pages, unique device identifiers and other diagnostic data.
When you access Service with a mobile device, this Usage Data may include information such as the type of mobile device you use, your mobile device unique ID, the IP address of your mobile device, your mobile operating system, the type of mobile Internet browser you use, unique device identifiers and other diagnostic data.
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Cookies are files with a small amount of data which may include an anonymous unique identifier. Cookies are sent to your browser from a website and stored on your device. Other tracking technologies are also used such as beacons, tags and scripts to collect and track information and to improve and analyze our Service.
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Examples of Cookies we use:
Examples of Cookies we use:
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4L Data Intelligence . uses the collected data for various purposes:
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(e) to gather analysis or valuable information so that we can improve our Service;
(f)to monitor the usage of our Service;
(g)to detect, prevent and address technical issues;
(h)to fulfill any other purpose for which you provide it;
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(j)to provide you with notices about your account and/or subscription, including expiration and renewal notices, email-instructions, etc.;
(k)to provide you with news, special offers and general information about other goods, services and events which we offer that are similar to those that you have already purchased or enquired about unless you have opted not to receive such information;
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(m)for any other purpose with your consent.
We will retain your Personal Data only for as long as is necessary for the purposes set out in this Privacy Policy. We will retain and use your Personal Data to the extent necessary to comply with our legal obligations (for example, if we are required to retain your data to comply with applicable laws), resolve disputes, and enforce our legal agreements and policies.
We will also retain Usage Data for internal analysis purposes. Usage Data is generally retained for a shorter period, except when this data is used to strengthen the security or to improve the functionality of our Service, or we are legally obligated to retain this data for longer time periods.
Your information, including Personal Data, may be transferred to – and maintained on – computers located outside of your state, province, country or other governmental jurisdiction where the data protection laws may differ from those of your jurisdiction.
If you are located outside United States and choose to provide information to us, please note that we transfer the data, including Personal Data, to United States and process it there.
Your consent to this Privacy Policy followed by your submission of such information represents your agreement to that transfer.
4L Data Intelligence will take all the steps reasonably necessary to ensure that your data is treated securely and in accordance with this Privacy Policy and no transfer of your Personal Data will take place to an organisation or a country unless there are adequate controls in place including the security of your data and other personal information.
We may disclose personal information that we collect, or you provide:
(a)Disclosure for Law Enforcement.
Under certain circumstances, we may be required to disclose your Personal Data if required to do so by law or in response to valid requests by public authorities.
(b)Business Transaction.
If we or our subsidiaries are involved in a merger, acquisition or asset sale, your Personal Data may be transferred.
(c)Other cases. We may disclose your information also:
- to our subsidiaries and affiliates;
- if we believe disclosure is necessary or appropriate to protect the rights, property, or safety of the Company, our customers, or others.
The security of your data is important to us but remember that no method of transmission over the Internet or method of electronic storage is 100% secure. While we strive to use commercially acceptable means to protect your Personal Data, we cannot guarantee its absolute security.
If you are a resident of the European Union (EU) and European Economic Area (EEA), you have certain data protection rights, covered by GDPR. – See more at https://eurlex.europa.eu/eli/reg/2016/679/oj
We aim to take reasonable steps to allow you to correct, amend, delete, or limit the use of your Personal Data.
If you wish to be informed what Personal Data we hold about you and if you want it to be removed from our systems, please email us at info@4LData.com.
In certain circumstances, you have the following data protection rights:
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(e) the right to data portability. You have the right to be provided with a copy of your Personal Data in a structured, machine-readable and commonly used format;
(f)the right to withdraw consent. You also have the right to withdraw your consent at any time where we rely on your consent to process your personal information;
Please note that we may ask you to verify your identity before responding to such requests. Please note, we may not able to provide Service without some necessary data.
You have the right to complain to a Data Protection Authority about our collection and use of your Personal Data. For more information, please contact your local data protection authority in the European Economic Area (EEA).
CalOPPA is the first state law in the nation to require commercial websites and online services to post a privacy policy. The law's reach stretches well beyond California to require a person or company in the United States (and conceivable the world) that operates websites collecting personally identifiable information from California consumers to post a conspicuous privacy policy on its website stating exactly the information being collected and those individuals with whom it is being shared, and to comply with this policy. – See more at: https://consumercal.org/about-cfc/cfc-education-foundation/california-online-privacyprotection-act-caloppa-3/
According to CalOPPA we agree to the following:
(a)users can visit our site anonymously;
(b)our Privacy Policy link includes the word "Privacy", and can easily be found on the page specified above on the home page of our website;
(c)users will be notified of any privacy policy changes on our Privacy Policy Page;
(d)users are able to change their personal information by emailing us at info@4LData.com.
Our Policy on "Do Not Track" Signals:
We honor Do Not Track signals and do not track, plant cookies, or use advertising when a Do Not Track browser mechanism is in place. Do Not Track is a preference you can set in your web browser to inform websites that you do not want to be tracked.
You can enable or disable Do Not Track by visiting the Preferences or Settings page of your web browser.
We may employ third party companies and individuals to facilitate our Service ("Service Providers"), provide Service on our behalf, perform Service-related services or assist us in analysing how our Service is used.
These third parties have access to your Personal Data only to perform these tasks on our behalf and are obligated not to disclose or use it for any other purpose.
We may use third-party Service Providers to automate the development process of our Service.
These third parties have access to your Personal Data only to perform these tasks on our behalf and are obligated not to disclose or use it for any other purpose.
GitHub
GitHub is provided by GitHub, Inc.
GitHub is a development platform to host and review code, manage projects, and build software.
For more information on what data GitHub collects for what purpose and how the protection of the data is ensured, please visit GitHub Privacy Policy page: https://help.github.com/en/articles/github-privacy-statement.
GitLab CI/CD
GitLab CI/CD is provided by GitLab, Inc.
GitLab CI (Continuous Integration) service is a part of GitLab that build and test the software whenever developer pushes code to application.
GitLab CD (Continuous Deployment) is a software service that places the changes of every code in the production which results in every day deployment of production.
For more information on what data GitLab CI/CD collects for what purpose and how the protection of the data is ensured, please visit GitLab CI/CD Privacy Policy page: https://about.gitlab.com/privacy/.
Our Service may contain links to other sites that are not operated by us. If you click a third party link, you will be directed to that third party's site. We strongly advise you to review the Privacy Policy of every site you visit.
We have no control over and assume no responsibility for the content, privacy policies or practices of any third party sites or services.
Our Services are not intended for use by children under the age of 18 ("Child" or "Children").
We do not knowingly collect personally identifiable information from Children under 18. If you become aware that a Child has provided us with Personal Data, please contact us. If we become aware that we have collected Personal Data from Children without verification of parental consent, we take steps to remove that information from our servers.
We may update our Privacy Policy from time to time. We will notify you of any changes by posting the new Privacy Policy on this page.
We will let you know via email and/or a prominent notice on our Service, prior to the change becoming effective and update "effective date" at the top of this Privacy Policy.
You are advised to review this Privacy Policy periodically for any changes. Changes to this Privacy Policy are effective when they are posted on this page.
If you have any questions about this Privacy Policy, please contact us at info@4LData.com.
©2023 4L Data Intelligence, Inc . All rights reserved.
These Terms of Service ("Terms", "Terms of Service") govern your use of our web pages located at http://www.4Ldata.com operated by 4L Data Intelligence
Your agreement with us includes these Terms ("Agreements"). You acknowledge that you have read and understood Agreements and agree to be bound of them
If you do not agree with (or cannot comply with) Agreements, then you may not use the Service, but please let us know by emailing at info@4ldata.com so we can try to find a solution. These Terms apply to all visitors, users and others who wish to access or use Service.
Thank you for being responsible.
By using our Service, you agree to subscribe to newsletters, marketing or promotional materials and other information we may send. However, you may opt out of receiving any, or all, of these communications from us by following the unsubscribe link or by emailing at.
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At the end of each Billing Cycle, your Subscription will automatically renew under the exact same conditions unless you cancel it or 4L Data Intelligence, Inc. cancels it. You may cancel your Subscription renewal either through your online account management page or by contacting 4L Data Intelligence customer support team.
A valid payment method, including credit card, is required to process the payment for your subscription. You shall provide 4L Data Intelligence with accurate and complete billing information including full name, address, state, zip code, telephone number, and a valid payment method information. By submitting such payment information, you automatically authorize 4L Data Intelligence to charge all Subscription fees incurred through your account to any such payment instruments.
Should automatic billing fail to occur for any reason, 4L Data Intelligence. will issue an electronic invoice indicating that you must proceed manually, within a certain deadline date, with the full payment corresponding to the billing period as indicated on the invoice.
4L Data Intelligence may, at its sole discretion, offer a Subscription with a free trial for a limited period of time ("Free Trial").
You may be required to enter your billing information in order to sign up for Free Trial
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At any time and without notice, 4L Data Intelligence reserves the right to (i) modify Terms of Service of Free Trial offer, or (ii) cancel such Free Trial offer.
4L Data Intelligence, in its sole discretion and at any time, may modify Subscription fees for the Subscriptions. Any Subscription fee change will become effective at the end of the then-current Billing Cycle.
4L Data Intelligence will provide you with a reasonable prior notice of any change in Subscription fees to give you an opportunity to terminate your Subscription before such change becomes effective.
Your continued use of Service after Subscription fee change comes into effect constitutes your agreement to pay the modified Subscription fee amount.
We issue refunds for Contracts within thirty (30) days of the original purchase of the Contract.
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These Terms shall be governed and construed in accordance with the laws of State of Delaware without regard to its conflict of law provisions
Our failure to enforce any right or provision of these Terms will not be considered a waiver of those rights. If any provision of these Terms is held to be invalid or unenforceable by a court, the remaining provisions of these Terms will remain in effect. These Terms constitute the entire agreement between us regarding our Service and supersede and replace any prior agreements we might have had between us regarding Service.
We reserve the right to withdraw or amend our Service, and any service or material we provide via Service, in our sole discretion without notice. We will not be liable if for any reason all or any part of Service is unavailable at any time or for any period. From time to time, we may restrict access to some parts of Service, or the entire Service, to users, including registered users
We may amend Terms at any time by posting the amended terms on this site. It is your responsibility to review these Terms periodically.
Your continued use of the Platform following the posting of revised Terms means that you accept and agree to the changes. You are expected to check this page frequently so you are aware of any changes, as they are binding on you.
By continuing to access or use our Service after any revisions become effective, you agree to be bound by the revised terms. If you do not agree to the new terms, you are no longer authorized to use Service.
No waiver by Company of any term or condition set forth in Terms shall be deemed a further or continuing waiver of such term or condition or a waiver of any other term or condition, and any failure of Company to assert a right or provision under Terms shall not constitute a waiver of such right or provision.
If any provision of Terms is held by a court or other tribunal of competent jurisdiction to be invalid, illegal or unenforceable for any reason, such provision shall be eliminated or limited to the minimum extent such that the remaining provisions of Terms will continue in full force and effect.
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© 2023 4L Data Intelligence . All rights reserved.