Opera Solutions Selected by the Centers for Medicare & Medicaid Services to Provide Operational and Fraud Analytics

Posted by Todd Higginson on Thu, Nov 15, 2012

NEW YORK, N.Y., Nov. 15, 2012 — Opera Solutions, LLC, a leading global Big Data science company, today announced that it has been selected by the Centers for Medicare & Medicaid Services (CMS) to provide advanced analytics to enhance operational controls and prevent fraud in federally funded Health Insurance Exchange Operations (“HIX”) managed by CMS’ Center for Consumer Information and Insurance Oversight (CCIIO). Opera Solutions will apply its unique healthcare claims data anomaly detection experience, in tandem with its extensive origination/eligibility and fraud detection expertise, to support CMS’ rollout of the Exchanges that begins in January 2014.

Health Exchanges are a critical component of the Patient Protection and Affordable Care Act (PPACA). Successful implementation requires oversight of the billions of federal dollars that will be spent on behalf of the Exchange enrollees, who include both individuals and small businesses. CMS is responsible for ensuring the financial integrity of these Exchange-related programs by making certain that eligible enrollees receive the appropriate assistance in joining qualified health plans. Market-wide oversight also will heighten the confidence of insurance providers participating in both Exchange and non-Exchange markets.

Opera Solutions has been selected to develop a secure and operationally efficient analytics capability, including Signal and Visualization Layers, in a large and complex distributed server environment. The company will develop and apply advanced pattern and anomaly detection algorithms against the flow of CCIIO data to monitor and evaluate mission-critical program functions and provide operational oversight for programs operating under the Exchanges. It will also develop, deploy, and support ongoing delivery of a robust analytics-based fraud surveillance program that provides continual monitoring and scoring in order to detect and prevent fraud, waste and abuse in the Exchanges and related programs.

“Any fraudulent activity and operational inefficiencies would burden taxpayers and reduce program resources available for those who truly need services,” said Arnab Gupta, CEO of Opera Solutions. “We are poised to put our advanced machine learning techniques and pattern detection science to work in building critical operational safeguards from the inception of these Exchanges. We are honored that CMS has selected Opera Solutions to support them in this critically important and game-changing effort in the public healthcare arena.”

Topics: Healthcare, Big Data, Press Releases