Utilizing our proprietary predictive modeling tools, MDPM^SM and S.P.I.E.S.^SM (Suspicious Payment Investigative Expert System) HRI is able to focus resources to identify and recover your money from vendors who have been over-paid. In the health care industry it is well known that, at a minimum, as many as 17% - 20% of claims are overpaid. Add in duplicate payments, multiple claim submissions, multiple payers who are often unaware of each other, and claims for services not actually provided and these numbers hold true in other industry situations as well. Utilizing the power of predictive modeling and proprietary algorithms to collect, assimilate, and profile known health care and insurance schemes against your claims payments, allows HRI to return a significant number of dollars that you may not even realize you have been losing. HRI can provide an end-to-end analysis to collection solution that will return dollars directly to your bottom line.

Meeting our clients' needs — Our client health plans are expected to do the impossible:

• Proactively identify fraudulent health care providers through data analysis
• React to "whistle-blowers" and other forms of fraud and abuse referrals
• Retrieve medical records and other evidence for case development
• Determine which cases move forward for audit
• Prosecute cases
• Recover funds and/or take punitive measures

Health Research Insights, Inc. (HRI) has been actively involved in health care fraud and abuse identification since 1997. Its executives have nearly a half century combined experience in both public and private health care fraud and abuse and understand their clients' needs.

HRI expertise includes the design, development and deployment of secure, HIPAA compliant, web portals. Through this portal, HRI can display data in an interactive on-line analytic processing (OLAP) format as well as customer specific defined reports utilizing our report wizard. Using a standard internet browser in a secure web environment provides you and your company with the ultimate in flexible functionality without the often enormous licensing fees charged by most data analysis vendors. BI tools provide you with information that is:

• Specific to your business needs
• Enable you to make decisions based on timely, actionable data
• Encompass all your health care and business data, including productivity measures and outcomes
• Allows you to allocate the right resources to the right targets
• Strengthens your ability to achieve the maximum return-on-investment

Data mining involves more than just pulling out pieces of data that fit a predefined category or format. Formally defined, data mining is the process of using statistical methods and artificial intelligence techniques, such as neural net technology, to discover subtle relationships between data items, and the construction of predictive models based on them. The term is commonly misused to describe software that presents data in new ways. True data mining doesn't just change the presentation but actually discovers previously unknown relationships among the data. Therefore, the process is not the same as just using an OLAP tool to find exceptional items. Generally, data mining is a very different and more specialist application than OLAP. The specialists at HRI have been engaged in statistical analysis, neural net construction, and predictive modeling for more than 20 years.

HRI's proprietary MDPM^SM technology lets you "look around the corner" to anticipate future events. HRI is able to incorporate multiple data sources (e.g. financial, utilization, and behavioral) to create neural net "learning systems" that increase in predictive ability over time. This will guarantee the correct allocation of resources, based upon business objectives, such as, identifying risks for high cost health care services, over or under payments, and the potential for fraud or abuse.

As a SAS Alliance Partner, HRI has access to the industry's most sophisticated analytic tools. Our M.D. and Ph.D. level research and business analysts develop reports that are business specific and designed to maximize the usefulness of your data. With an experienced staff of medical researchers, epidemiologists, nurses, statisticians, with expertise in experimental and survey design, HRI is able to design statistically valid studies and survey instruments to validate outcomes and return on investment calculations. HRI provides the information you need to make informed business decisions.

HRI maintains data storage facilities that are Health Insurance Portability and Accountability (HIPAA) compliant and fully protected in the event of natural or man made disasters. Configured to provide virtually limitless storage capacities, HRI's data center provides each data set individualized attention. Data sets are never mixed or co-mingled; each data set is fully insulated and protected.

HRI is skilled in the creation and presentation of your data in clear, concise and meaningful ways. Whether the format is graphic, tabular, narrative or presentation, (e.g., audio, video, PowerPoint) HRI can highlight your data to reveal those that have the greatest impact on business goals and objectives.

HRI has years of experience assisting project managers turn mounds of research information into White Papers, articles for publication or narrative reports utilizing appropriate statistical, scientific and industry specific language. HRI has produced project saving reports for some of Medicare's largest contractors. In fact, HRI has come to be known as the "911" for many Medicare projects in need. HRI's technical writers draw from experience in Medicare, Medicaid, commercial health care, statistical analysis, epidemiology, medicine, psychology, the armed services, computer programming, and a host of backgrounds. This broad knowledge base makes HRI the perfect complement to any project.

HRI can provide board certified, licensed, experienced Medical Director support for your project based or part-time needs. Our experience spans Medicare, Medicaid and commercial insurance products. Medical expense action planning, utilization program design and management, data review and analysis are only a few of the services HRI provides every day to clients around the country.

HRI maintains a team of highly qualified degreed professionals capable of designing and implementing statistically and clinically valid studies. Together with careful front end management, our years of experience in clinical and experimental research and survey design allow us to navigate your project through the obstacles that threaten to lessen the impact of your work.

HRI has years of experience developing winning proposals that are timely, compliant, and designed to address the key issues and needs of the issuing company, department or agency. The HRI approach begins with detailed analysis of the motivating events or factors leading to the issuance of the RFP or bid request. The document is then dissected to identify required or key features, timeframes, formats and informational details that will lead to a successful response. Strategic, legal, financial and operational objectives are then developed into a project matrix designed to hit all the right points and meet all the right timelines.

HRI professionals have over a century of management experience. Whatever the scope and size of your project, HRI can help you:

• define the expected objectives
• minimize the impact on your resources needed for other projects
• maximize the effectiveness of meetings, workgroups, teams or process flows
• set and meet realistic milestones and deadlines
• create the cohesive team approach needed to get the job done on time and under budget

Our medical and technical consultants are highly qualified professionals with experience in pre-trial consultation, expert witness report preparation, deposition testimony, as well as standing up under cross examination. Cases are accepted based on an individual analysis of the skill set(s) needed and the client's specific needs.