MINNEAPOLIS & NASHVILLE, Tenn.--()--FICO (NYSE:FICO), the leading provider of analytics and decision management technology, and Emdeon Inc (NYSE:EM), a leading provider of healthcare revenue and payment cycle management solutions, today announced a commercial agreement aimed at preventing fraud, waste and abuse in the health insurance system. Under the alliance, Emdeon will incorporate FICO™ Insurance Fraud Manager into its leading healthcare revenue and payment cycle transaction processing network in order to offer an enhanced fraud prevention solution to the 1,200 payers currently using Emdeon. Emdeon operates the single largest financial and administrative information exchange in the U.S. healthcare system. The parties believe the combination of Emdeon’s healthcare data and central position in the healthcare workflow, complemented by FICO’s sophisticated analytics, will result in a unique solution to the marketplace.
“Management's Discussion and Analysis of Financial Condition and Results of Operations”
Industry estimates place the cost of healthcare fraud, waste and abuse at $200 to $600 billion annually – costs that are ultimately borne by health insurance payers and consumers. FICO and Emdeon identified millions of dollars in cost saving opportunities when they examined claims with indications of fraud, waste or abuse during a pilot study performed with de-identified data from just two U.S. states.
“Creating an efficient healthcare system helps all stakeholders: payers, providers and consumers, and that is why it is one of Emdeon’s top priorities,” said George Lazenby, chief executive officer of Emdeon. “By putting FICO’s advanced, predictive fraud analytics into the hands of payers who pay the nation’s healthcare claims, we are helping our customers address one of the largest, most debilitating sources of friction in the healthcare system and ultimately creating change that will lead to efficiency.”
Losses due to fraud, waste and abuse are estimated to run 2-10 percent or more of the $2 trillion spent on healthcare today. At the high end of this range, that would translate to an estimated $10 per $100 of healthcare dollars spent on fraud. When compared to the 7 cents per $100 spent on fraud in the credit card industry, where FICO’s fraud management solution is the industry standard, healthcare fraud is more than one hundred times the approximate rate of fraud-related losses in the credit-card industry.
“As Congress and the American people grapple with the magnitude of the landmark Healthcare Bill, our work with Emdeon is focused on a very practical matter: reducing the costs borne by healthcare payers and taxpayers,” said Mark Greene, chief executive officer at FICO. “FICO fraud management technology has made an enormous impact on the credit card industry since its introduction in 1992, cutting losses by an estimated $10 billion over that period of time. Together with Emdeon, we intend to make a similar contribution in healthcare.”
According to Maureen O’Neil, principal research analyst for insurance, Gartner, “Accurately detecting fraud, waste and abuse ahead of payment remains largely elusive for most health insurers. Healthcare reform will require a paradigm shift for fraud, waste and abuse detection that will require health insurers to evolve to a pre-pay, pre-adjudication review. This will demand new IT capabilities, an enhanced role for risk management and a profound cultural change among health insurers.”
“Healthcare represents one-seventh of the U.S. economy, and it’s rife with examples of fraud,” said Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association. “By increasing awareness and improving the detection and prevention of healthcare fraud, we can begin to impact the continuing yet burgeoning market need of controlling soaring healthcare costs.”
FICO (NYSE:FICO) transforms business by making every decision count. FICO’s Decision Management solutions combine trusted advice, world-class analytics and innovative applications to give organizations the power to automate, improve and connect decisions across their business. Clients in 80 countries work with FICO to increase customer loyalty and profitability, cut fraud losses, manage credit risk, meet regulatory and competitive demands, and rapidly build market share. FICO also helps millions of individuals manage their credit health through the www.myFICO.com website. Learn more about FICO at www.fico.com.
Emdeon is a leading provider of revenue and payment cycle management solutions, connecting payers, providers and patients in the U.S. healthcare system. Emdeon's product and service offerings integrate and automate key business and administrative functions of its payer and provider customers throughout the patient encounter. Through the use of Emdeon's comprehensive suite of products and services, which are designed to easily integrate with existing technology infrastructures, customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle process. For more information, visit www.emdeon.com.
FICO Statement Concerning Forward-Looking Information
Except for historical information contained herein, the statements contained in this news release that relate to FICO or its business are forward-looking statements within the meaning of the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995. These forward-looking statements are subject to risks and uncertainties that may cause actual results to differ materially, including the success of the company’s Decision Management strategy and reengineering plan, the maintenance of its existing relationships and ability to create new relationships with customers and key alliance partners, its ability to continue to develop new and enhanced products and services, its ability to recruit and retain key technical and managerial personnel, competition, regulatory changes applicable to the use of consumer credit and other data, the failure to realize the anticipated benefits of any acquisitions, continuing material adverse developments in global economic conditions, and other risks described from time to time in FICO’s SEC reports, including its Annual Report on Form 10-K for the year ended September 30, 2009, and its last quarterly report on Form 10-Q for the period ended December 31, 2009. If any of these risks or uncertainties materializes, FICO’s results could differ materially from its expectations. FICO disclaims any intent or obligation to update these forward-looking statements.
Emdeon Statement Concerning Forward–Looking Information
Statements made in this press release that express Emdeon's or management's intentions, plans, beliefs, expectations or predictions of future events are forward-looking statements, which Emdeon intends to be covered by the safe harbor provisions for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995. These statements often include words such as "may," "will," "should," "believe," "expect," "anticipate," "intend," "plan," "estimate" or similar expressions. Forward-looking statements may include information concerning Emdeon's possible or assumed future results of operations, including descriptions of Emdeon's revenues, profitability and outlook and its overall business strategy. You should not place undue reliance on these statements because they are subject to numerous uncertainties and factors relating to Emdeon's operations and business environment, all of which are difficult to predict and many of which are beyond Emdeon's control. Although Emdeon believes that these forward-looking statements are based on reasonable assumptions, you should be aware that many factors could affect Emdeon's actual financial results or results of operations and could cause actual results to differ materially from those in the forward-looking statements, including the risks discussed in the "Risk Factors" and "Management's Discussion and Analysis of Financial Condition and Results of Operations" sections and elsewhere in Emdeon's Annual Report of Form 10-K for the year ended December 31, 2009, as filed with the SEC, as well as Emdeon's periodic and other reports filed with the SEC.
You should keep in mind that any forward-looking statement made by Emdeon herein, or elsewhere, speaks only as of the date on which made. Emdeon expressly disclaims any intent, obligation or undertaking to update or revise any forward-looking statements made herein to reflect any change in Emdeon's expectations with regard thereto or any change in events, conditions or circumstances on which any such statements are based.
FICO and Insurance Fraud Manager are trademarks or registered trademarks of Fair Isaac Corporation in the United States and other countries.