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Tune in Thursday, June 11 at 2:00 PM EDT
Federal healthcare systems are under increasing pressure to do more than deliver care. They are also responsible for managing risk at an enormous scale. Billions of dollars are lost each year to fraud, waste and abuse, yet in many cases, the cost of investigating and recovering improper payments exceeds the value of the claims themselves. This has led to a persistent “pay and chase” model, where questionable claims are paid first and only reviewed later, if at all. With increased scrutiny from oversight bodies and initiatives like the Task Force to Eliminate Fraud, agencies are under pressure to rethink this approach. The challenge moved beyond simply identifying fraud to doing so early enough, and efficiently enough, to make intervention worthwhile.
In this webcast, we’ll explore how federal healthcare leaders are shifting fraud detection closer to the point of payment by rethinking data architectures and distributing decision-making. We’ll discuss how AI and edge computing can help agencies move from retrospective review to real-time risk assessment, reducing improper payments while lowering the cost of enforcement. The conversation will focus on how bringing intelligence to where decisions are made can strengthen program integrity without slowing down care delivery.
Speakers
Ben Cushing
Senior Principal Chief Architect, Health & Life Sciences
Red Hat
Ben Cushing
Senior Principal Chief Architect, Health & Life Sciences
Red Hat
For two decades, Ben Cushing has been a leader in emerging technology solutions across multiple industries and is committed to radical innovation in healthcare. Before joining Red Hat, he served as the Chief Technology Officer for MDLogix, a behavioral health IT firm supporting Johns Hopkins Medicine. There he architected and brought to market a behavioural health cloud platform for use with employer, healthcare, and education markets.
In addition to supporting analytics and operations at the National Institutes of Health for 6 years, Cushing had the opportunity to practice a scaled agile framework with Accenture where he led the technical architecture and design for the Department of Veterans Affairs’ (VA) Electronic Health Management Platform, an industry leading Health Management and Care Coordination platform serving 9 million patients.
His tenure at Accenture began with the acquisition of Agilex, where he designed LSI solutions, developed systems to automate the Post-9/11 GI bill, and supported in-theater data collection and analytics tools. While at Agilex, Ben architected and led the development of a mobile Software Development Kit, still in use today by the VA to produce more than 60 applications.