Fraud, Waste and Abuse Case Tracking Management and Recovery System

Trail Tracker™ is an advanced fraud, waste and abuse case tracking management and recovery system built exclusively for healthcare payors that builds, documents and manages alleged FWA cases through investigation, prosecution and settlement.

Trail Tracker is a comprehensive fraud, waste and abuse case tracking management and recovery system that works across all healthcare claim types, including, medical, facility, pharmaceutical and dental. The easy-to-use Graphical User Interface (GUI) enables the investigator to plan a course of action for each investigation, identify activities needed, document investigations, create reminders and manage records. The workflow design allows for tracking cases by status, tracking referral tips, assigning claims to specific departments for review, assigning cases to investigators and managing investigator workloads. Trail Tracker also gives Special Investigations Unit (SIU) management an effective tool to measure investigator progress on files, trace recoveries, calculate savings and create reports on unit activities.

With Trail Tracker, investigators can seamlessly interface with numerous departments within the company, as well as a variety of outside entities, such as, providers, patients, pharmacies, local, state and federal law enforcement agencies, Office of the Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS). Because each organization has its own policies and procedures regarding investigation protocols and claim adjudication, the system is designed for maximum flexibility in configuration.

Trail Tracker integrates fully with Intelligent Investigator™ our advanced fraud detection system. Intelligent Investigator pinpoints patterns of suspicious behavior across all healthcare claim types, including, medical, facility, pharmaceutical and dental. Both are written in modern java and will instantly run on any networked PC, or are available as a SaaS (Software as a Service) fully hosted option.

At a glance, this system allows for:

• Prioritization of workload
• Detailed explanations of why a provider should be investigated
• Quick and comprehensive management reports for proper response to legal authorities as well as identifying opportunities for training SIU staff
• A single system for storing all information relevant to a case
• Tracking correspondence with contacts