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Reducing healthcare costs for self-funded employers

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News & Blog

SmartLight Analytics grew out of a desire to take meaningful action on rising healthcare costs

In August 2016, SmartLight Analytics was founded out of a desire to help employers deal with the rising cost of healthcare and make an impact that would not only help big companies but thousands of their employees as well. Employee healthcare costs are expected to top $15,000 per employee in
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Pass-through billing schemes

“Healthleaders Media” recently reported on a case involving pass-through billing in Florida which highlights how such schemes can grow if undetected during regular claims reviews. The case involved the owner of a substance abuse treatment facility who sent his patients’ urine samples to a lab that returned 40% of the
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CASE STUDY: Uncovering potential abusive billing

June 2019   During monthly monitoring of a client’s claims, the SmartLight Analytics’ team identified potential abusive billing by a licensed in-network physician who owns a family practice in Texas. The issue was identified due to an abnormal billing pattern in comparison to provider peers.  The suspicious claim pattern included repeated payments
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Phantom billing: Can you spot it in your claims?

Three seemingly unrelated imaging providers based in FL were identified in a self-funded employer’s medical claims for what was later verified as phantom billing. The utilization patterns seen in paid claims history for an employee and his wife indicated a strong probability of “phantom” billing – billing for services never
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Cosmetic Surgery Is Ripe for Fraud

Multiple healthcare fraud schemes have been investigated over the years involving providers who misrepresent cosmetic procedures as medically necessary ones to increase patients and their profit. Rhinoplasty is known to be the most common procedure that is inappropriately billed to health insurance. Surgeons charge for repair of a “deviated septum”
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Recent Posts

  • SmartLight Analytics Ranks No. 148 on the 2022 Inc. 5000 Annual List  
  • High volume of small errors can add up to millions in waste for your health plan
  • The impact of transparency requirements on the healthcare system
  • City of Fort Worth prevents $1.7 million in fraudulent pharmacy payments
  • Data Solution to Tackle Fraud, Waste, and Abuse

See all SmartLight Blog posts.

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SmartLight White Papers

The expanding cost and responsibilities associated with employer-sponsored healthcare

As the rising costs of healthcare benefits and the rising percentage of employee contributions converge, companies across America are faced with a new scenario that finds them looking for ways to reduce healthcare spending and protect their employees’ contributions. How should a business whose mission is to build cars or develop software deal with this increasingly complicated situation?

Download SmartLight’s Whitepaper:

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SmartLight Analytics combines the best inferential analytic models with a team of analytic  and clinical experts to find fraud, waste, and abuse in self-funded employer health care plan claims data.
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SmartLight Analytics has been named finalists in D CEO Magazine Excellence in Healthcare Awards 2020 for Outstanding Service Innovation.

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