Emdeon is taking on the dark side of healthcare finance.
The Nashville-based provider of revenue and payment cycle solutions is targeting the billions of dollars lost each year in healthcare fraud by acquiring The Sentinel Group, a developer of data analytics solutions and technology designed to ferret out healthcare fraud and abuses.
“We are delighted about this opportunity and the benefits it will bring to our customers," said George Lazenby, Emdeon’s CEO, in announcing the acquisition on Tuesday. “Billions of dollars are lost every year to healthcare fraud, and that drives up costs for patients, doctors, hospitals, insurers, employers and ultimately U.S. taxpayers”
“Emdeon is the single largest financial and administrative information exchange in the U.S. healthcare system,” he added. “By integrating The Sentinel Group's technology and intelligence into Emdeon's existing workflow, we have the opportunity to generate tremendous savings for both the public and private sectors.”
Emdeon has agreed to acquire substantially all the assets of Lake Forest, Ill.-based Sentinel from Optimal Business Services, Inc., a subsidiary of the Trustmark Holding Company. Specific terms of the agreement, expected to close during the second quarter, were not disclosed.
According to the National Health Care Anti-Fraud Association, healthcare spending in the United States topped $2.26 trillion in 2007. Of that figure, approximately 3 percent to 10 percent – between $68 billion and $226 billion – is lost each year to fraud, according to the FBI and NHCAA. Those numbers have prompted 41 states to establish anti-fraud efforts, with several enacting laws to require insurers to set up programs to identify insurance fraud and outline actions to reduce fraud.
“Right now, healthcare costs and their impact on the economy are top priorities across our nation,” said Gary Stuart, Emdeon’s executive vice president. “Emdeon's mission is to make healthcare more efficient. Now we will have another way to help make payments more efficient – and take costs out of healthcare – during a critical time for the healthcare industry and our economy.”
Sentinel Group officials say they have spent nearly 19 years combining data analytics and fraud investigations for their customers, evolving into its own unit from within Trustmark’s employee medical records division. As part of the deal, Trustmark companies will remain long-term customers of The Sentinel Group.
“We are very excited to become a part of the Emdeon family,” said Kelli Garvanian, vice president of The Sentinel Group, who will join Emdeon once the deal is complete. "We look forward to working together to create new opportunities and be part of the solution as our nation tackles healthcare costs and reforms.”
