Government Health Care Solutions

Modernize Medicaid Management

Saving lives, improving outcomes and controlling costs through data-driven policy decisions.

How SAS® Helps Modernize Medicaid Management

Provide better care

Achieve intended outcomes in the face of internal and external constraints.

Enhance program integrity

Detect and prevent fraud, waste and abuse before money goes out the door.

Reduce costs

Effectively manage costs and demonstrate effectiveness.

Why choose SAS for Medicaid modernization?

Gain holistic data insights and enhanced information credibility.

  • Seamlessly integrate any enterprise data source and apply embedded data quality techniques to improve accuracy.
  • Gain a holistic view of a recipient or provider to better detect anomalies or discrepancies across government programs or systems.
  • Enable data scientists with varied programmatic skill sets to work in their preferred programming language.

Focus on prepayment.

Our hybrid approach combines anomaly detection, rules and predictive modeling to identify fraud, waste and abuse earlier than traditional methods by applying:

  • Predictive modeling rules. Ensure that known schemes are detected with a program integrity solution that includes an embedded rules library.
  • Unsupervised learning. Proactively predict where fraudulent activities will occur.
  • Machine learning models. Get faster, better modeling results from our solution, which includes industry best practice predictive modeling templates, hyperparameter autotuning and embedded model interpretability – all accessed through an intuitive interface.

Featured Solution

SAS Detection and Investigation for Health Care

SAS delivers a comprehensive solution for detecting and prevent health care fraud, waste and abuse at every stage of the claims process, and stopping improper payments before claims are paid. The solution uses advanced analytics with embedded AI and machine learning algorithms, combined with other techniques – business rules, outlier analysis, text mining, database searches, exception reporting, network link analysis, etc. – to uncover more suspicious activity with greater accuracy.

What Analysts Are Saying

Aite Matrix: Payment Integrity in Healthcare

"SAS’ legacy and strength in data analytics and aggregation come into play at a time when health plans can benefit from robust analytics capabilities to uncover irregular claim submissions."

The Forrester Wave: Enterprise Fraud Management

SAS is the only vendor in the evaluation to earn a 5 out of 5 score in the model explainability and governance criterion.

Chartis RiskTech Quadrant for Enterprise Fraud Solutions

"SAS delivers the architecture that is most appropriate for the type of fraud an organization is tackling – real-time payments, for example, and/or card fraud, application fraud and deposit monitoring."

SAS in the Public Sector – Facts & Figures

>700

public sector departments, ministries, offices & agencies using SAS worldwide

50

US state governments using SAS to solve their most complex problems

134

countries rely on SAS in the public sector for reliability and accuracy

Recommended Resources for Modernizing Medicaid Management

Webinar

Make smarter, faster decisions in Medicaid management

Take a fresh look at how analytics helps leading Medicaid agencies make the rapid, data-driven decisions needed to manage increasingly complex programs.

Webinar

Identity Theft – Who’s Who in Health Care

Join us and review the emerging challenges in combating and preventing identity theft in health care and government programs.

Solutions

Public Sector Analytics Solutions for Combating COVID-19

Explore how SAS can help you adapt to today's new economic and social climate and plan for the future – with confidence.

Solution Brief

Detect & prevent Medicaid fraud & improper payments to improve your state budget

Discover how to thwart today’s sophisticated fraud schemes and methods by consolidating data from internal and external sources on providers and beneficiaries, coupled with advanced analytics.

Solutions

SAS Public Health & Government Health Care Solutions

Learn how SAS helps public sector health agencies better quantify public health needs, monitor progress in service delivery, assess the impact of population health programs, and identify and address inequities.

White Paper

Fighting the Rising Tide of Medicaid Fraud

Medicaid fraud has jumped dramatically in the era of COVID, and states must respond by accelerating their deployment of big data, predictive analytics and integrated technology platforms to manage Medicaid programs and prevent fraud. This white paper explores the challenges and opportunities this presents.

Connect with SAS and see what we can do for you.