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Abstract Background

The New Standard
in Data Analytics and Prevention

Use SGS to prevent Fraud, Waste and Abuse in your program. 

25

Years of Experience in Fraud Waste and Abuse

SGS Protects

We Take Pride In Our  Numbers

81M

Millions of Beneficiaries Covered by SGS

571,000

Number of Providers

22

States and Territories

Served by SGS

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15

Years of Experience

10K

Business Partners

25M

Products Installed

22

Countries World Wide

5

Industry Awards

61%

Percent of Inappropriate dollars saved  Preventative

34%

Percent of inappropriate dollars saved Recovered

5%

Percent of inappropriate dollars saved Revocations

Let our Solutions Protect Your Program 

When you  work with SafeGuard Services LLC (SGS),  you  work with  a  team  that  is:

 

  • Effective – SGS effectiveness has allowed  the organization  to grow  to become  one of the largest   contractors addressing  fraud,  waste and abuse for Centers for Medicare & Medicaid Services (CMS).  

  • Secure – The data being  analyzed is highly protected.  The  SGS  Security program  is based  on  the  National Institutes  of Standards and Technology  (NIST) 800-53 security controls  to  allow SGS  to conform  to requirements for federal  systems, auditable  under the Federal Information  Security  Management Act (FISMA). 

Medical necessity review is performed by a highly skilled SGS clinician who considers rules and policies as well as standard medical practices in evaluating the services performed and claim billed.

SGS applies over 24 years of experience in FWA to promote loss prevention by recommending enhancements to payment systems, to proactively pay claims correctly, and minimize future overpayments.

SGS data analysts and statisticians apply a wide range of detection capabilities, including predictive modeling and complex data mining

SGS Investigators substantiate the allegations by analyzing associated records.  Desk-level investigations include analyzing information about a subject such as enrollment, claims, and other background data.

Unprecedented capabilities. Impeccable reliability.

Our experience  with  fraud  and  abuse  analytics has  resulted  in the referral of thousands  of cases  to law   enforcement  and  resulted  in  successful criminal and  civil  prosecution  and  civil  monetary  penalties. Benefits of  the  program  safeguard  services offered  by  SGS  include:

 

  • Increased profitability  through  recovery  of  past overpayments and through  mitigation  of  future fraud, waste, and abuse loss

  • Ability  to conduct  predictive  analysis  to support investigations

  • Reduced risk of predatory  attacks through strengthened policies  and enhanced  use  of automated   prepayment  protection

  • Reduced risk of adverse publicity and increased potential for positive publicity regarding proactive   approach to address fraud,  waste and abuse

  • Collaboration with  stakeholders  on  approach and preventive  measures 

Are You Ready to Accelerate Your Business?

Download our Brochure

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