Hope Community Resources Fights Medicaid Fraud with ACL Software

ACL, the company that is transforming audit and risk, announced today that Hope Community Resources (Hope) has selected ACL’s data analysis software to identify and prevent revenue leakage related to Medicaid fraud. After an extensive review of audit technologies, Hope concluded that ACL’s suite of products provided a complete, end-to-end technology solution that would enable the organization’s internal audit team to complete audits in a matter of days, as opposed to the team’s previous process, which could take up to several weeks.

Headquartered in Anchorage, Alaska, Hope is a non-profit organization that provides support to over 1,200 families and individuals throughout the state who experience disabilities. With 77% of the organization’s business funded through Medicaid, prevention of revenue leakage related to fraud is a top priority.

Hope faced the challenge of conducting audits and investigations through a lengthy process that involved scrubbing and analyzing data produced by three independent sources: Human Resources, Financial, and Medical Records. The audit team wanted to automate this manual process to achieve a higher level of productivity with regard to assuring compliance with state and federal regulations.

“Our internal audit team spent an enormous amount of time and resources scrubbing data across three separate platforms,” said Dan Maples, CIO of Hope Community Resources. “Not only does ACL technology streamline our audit capabilities, they were the only company to provide a full audit solution – and ACL’s dashboarding and visualization technology really wowed us.”

ACL addresses Hope’s priorities by automating data cleansing and data mining between various systems. This eliminates analysis gaps and will enable three-way matching between their systems, resulting in more efficient audits and fraud detection.

“Assuring compliance, improving billing accuracy, and achieving a higher level of organizational efficiency are key immediate goals,” said Esther Loy, Administrator of Internal Audit and QA at Hope Community Resources, “We plan to eventually deploy ACL data analytics across other areas of the business to improve accounts payable, purchase-to-pay, and IT audits.”

“Optimizing resources and preventing fraud is in the spotlight for healthcare organizations,” said Laurie Schultz, President and CEO of ACL. “With the Federal Bureau of Investigations estimating 3-10% of all health care expenditures attributable to fraud on an estimated $2.5 trillion annual US health care spend, data analytics software has an important role to play in managing the costs of healthcare and healthcare insurance.”[1]

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About ACL
ACL delivers technology solutions that are transforming audit and risk management. Through a combination of software and expert content, ACL enables powerful internal controls that identify and mitigate risk, protect profits, and accelerate performance.

Driven by a desire to expand the horizons of audit and risk management so they can deliver greater strategic business value, we develop and advocate technology that strengthens results, simplifies adoption, and improves usability. ACL’s integrated family of products — including our cloud‐based audit and compliance management solution and flagship data analytics products — combine all vital components of audit and risk, and are used seamlessly at all levels of the organization, from the C‐suite to front line audit and risk professionals and the business managers they interface with. Enhanced reporting and dashboards provide transparency and business context that allows organizations to focus on what matters.