Verisys – Dedicated To Preventing Fraud, Waste And Abuse For Leading Organizations

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Verisys provides a comprehensive technology platform of data, analytics and services catering to the full spectrum of organizations in the health care sector. Verisys’ mission is to protect health care consumers by enforcing competency and patient safety through transparency. As stewards of provider data, Verisys is one of only a few Credential Verification Organizations both URAC accredited and NCQA certified for 10 out of 10 verification services. Verisys is dedicated to mitigating legal, financial, and regulatory risk for its clients and their end-users by preventing fraud, waste, and abuse in health care. Verisys returns accurate and timely data on individuals, professionals, and businesses for contracting, credentialing, privileging, employment, enrollment, reimbursement, and referral validation purposes.

Below is our interview with John P. Benson, CEO of Verisys:

Q: John, could you tell us something about your products?

A: CheckMedic® by Verisys, is an integrated workflow, compliance, credentialing and monitoring solution that ensures all individuals and entities are properly licensed, certified, registered, fully compliant, and meet regulatory best-practices criteria. This end-to-end, cloud-based SaaS tool increases productivity, lowers costs, reduces administrative burden, and elevates accuracy.

ProviderCheck® by Verisys is a transactional prescriber and provider verification and monitoring solution. It checks pass/fail criteria at the time of dispensing or reimbursement for transparent processing that eliminates non-reimbursable events, loss of inventory, loss of revenue, and potential abuse and fines. ProviderCheck is one of the most effective transactional tools to expose bad actors at the heart of the opioid abuse crisis.

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Q: What is one of the greatest challenges for health care institutions today?

A: Fraud, Waste and Abuse are the key issues facing health care historically and today. Verisys has developed data, technology and tools that support the philosophy of prevention and gatekeeping. The bottom line of protecting patients is keeping bad actors from practicing medicine and endangering patients. Verisys is the only CVO (Credential Verification Organization) that has API connection to more than 5,000 primary sources, aggregates and works algorithmically with more than 8 million records (current and historical), actively scrapes data from primary-source publishers and can deliver critical data in real time through a quick dashboard all the way to an end-to-end enterprise platform that manages through individual MedPass profiles each individual in a health care institution. This leads to the OPIOID crisis where Verisys has designed and created ProviderCheck that can, with widespread use, prevent the dispensing of opioids prescribed illegally. That accounts for a huge amount of opioids on the streets causing harm and death.

Q: What industries do you serve?

A: At large, the health care industry. Within that, hospitals, payers, pharmacy chains, research. Any institution in the health care arena that is either required to uphold compliance to federal reimbursement standards, or who considers sound screening, verifying and monitoring as part of best practices.

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Q: What are your plans for the future?

A: To implement the CheckMedic platform throughout the health care industry resulting in every health care provider to have a MedPass Profile giving full transparency to the federal entitlement system eliminating the game of pay and chase, as well, that health care consumers will have access to the Verisys consumer application currently in development. With the consumer-facing level of expectation for transparency, the collective of health care consumers will force institutions to a more accountable level of transparency on its providers, staff and vendors.

Verisys finds on a regular basis in searching providers against its proprietary data set, FACIS, that of the providers listed in a payer’s provider directory, an alarming percentage are: unlicensed, excluded, currently incarcerated, on the sex offender and abuse registries, and on the OFAC+ watch list. Some are working under several NPI numbers (illegal and usually indicating errant behavior) and many are prescribing outside of their prescriptive authority. The data and systems exist with Verisys to put a sudden halt to this level of fraud, waste and abuse. Now it’s just a matter of spreading the word.