Safety assured: Secure healthcare fraud prevention in the cloud

The challenges of maintaining Protected Health Information (PHI) security

The digital transformation that has spread across many industries also offers remarkable promise in healthcare to save lives and eliminate inefficiencies. However, healthcare has been one of the slowest industries to embrace the new data-driven possibilities – not because of a lack of promise, but because those in the industry are rightly averse to the risks of data breaches. Last year alone, the number of cases of medical identity theft jumped 21%, with each incident costing victims an average $13,500 to fix.

Part of the risk arises from the number of parties that are involved in the healthcare experience. It’s not just the healthcare provider that needs to worry about data security. Each new set of hands that PHI passes through – providers, suppliers, payers, partners – has the potential to be the weak link that allows the leakage of healthcare information. This means that any party involved in the handling of PHI must be subject to the highest scrutiny to ensure that they’re up to the task of keeping that data safe.

Healthcare payers and their technology partners are no exception. They have their own fraud issues to be concerned about – preventing and recovering improper payments – but it’s imperative that they do so in a way that protects sensitive patient information and is compliant with government regulations. In the US, the HIPAA Omnibus Rule holds business associates (such as cloud computing providers) to the same standards of PHI protection as covered entities.

Because of the risk to patients inherent in digitizing PHI, and because of the risk of falling out of compliance, the healthcare industry has been hesitant to embrace the digital age with cloud-based partners. Healthcare payers need trusted partners who can help them catch up to the technological innovation in other industries, all while ensuring data security.

Fighting claims fraud while protecting PHI in the cloud with CGI ProperPay

CGI ProperPay for claims analytics is a solution for healthcare payers that helps them to analyze healthcare claims and screen out fraud, waste, and abuse – all with the security and velocity of the Microsoft Azure cloud. CGI and Microsoft understand the gravity of protecting personal information, and have the experience and qualifications to keep data safe.

Microsoft’s Azure cloud has more security qualifications than any other cloud provider. Azure meets a broad set of international and industry-specific compliance standards, such as ISO 27001, HIPAA, FedRAMP, SOC 1 and SOC 2. Its HIPAA Business Associate Agreement (BAA) stipulates adherence to HIPAA’s security and privacy provisions.

And just this January, Azure became one of the first hyper-scale cloud computing platforms to become HITRUST CSF certified. The HITRUST Certification is the most widely recognized security accreditation in the healthcare industry. It incorporates healthcare-specific security, privacy, and regulatory requirements with industry best practices.

And with CGI ProperPay, data security doesn’t have to come at the cost of efficacy. Azure’s matchless speed means that healthcare payers can make the most of their data quickly and see value rapidly. CGI ProperPay detects trends and patterns to identify improper payment scenarios by leveraging cutting-edge analytics techniques from the Cortana Intelligence Suite, while also providing a fully customizable set of rules and comprehensive data management. In the last five years alone, the industry-leading solution has returned $2.5 billion in improper payments to its clients.

Innovate boldly – and securely

The digital transformation of the healthcare industry has been understandably slow, given the threat of data breaches and the weight of regulatory pressures. However, it is imperative that healthcare leaders recognize the immense, life-saving value of technological innovation in this industry, and rise to the challenge of ensuring the data security that will make this possible. Healthcare payers that choose to partner with CGI and Microsoft are promoting quality healthcare at lower prices by fighting fraud, waste, and abuse with one of the best tools available. And they can do so knowing that their data will be safe and secure.

Newly rebuilt on the cloud, CGI ProperPay for claims analytics is available on the Microsoft AppSource marketplace. Learn more about how CGI ProperPay can help healthcare payers successfully and securely fight fraud, waste, and abuse.

Jenn Roth

Director, Global Healthcare Product Marketing Microsoft Global Industry Marketing

Jenn Roth leads Microsoft’s healthcare and life sciences product marketing strategy and GTM messaging for the Global Industry Product Marketing team. She is the solution program lead for the Microsoft Cloud for Healthcare. Her experience includes hospital administration, product marketing, global communications, and commercialization across Class III medical devices and clinical SaaS applications.

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