Attorney Howard Pierce was recently interviewed for the Hartford Business Journal article, “Law firm Halloran Sage uses data analytics to detect healthcare cost fraud and abuse.”
Howard and his team have decades of experience representing commercial group healthcare payers and self-funded plans across the country, saving and recouping money paid to fraudulent providers. Their practice is unique: the group has pioneered the design and application of regression analysis with statistical analytics to determine fraud and abuse in health care claims submitted to its clients. These proprietary algorithms along with industry sources assist in first discovering the fraud and abuse, and then recovering monies overpaid to providers.
As detailed in the article, prior to joining Halloran Sage last April, Howard and his team (including attorney Stephanie Gitlin, paralegal Phyllis Barber-Smith, and Chief Data Scientist Daniel Sandoval, PhD) recovered more than $4.4MM on behalf of the U.S. government and $245MM for insurers. The team has recovered $10.4MM on behalf of the U.S. government and $246MM for insurers. They have also recently been uncovering patterns of fraud and abuse such as upcoding and double billing within COVID-19 testing practices.
The group develops cases in pre-litigation and typically settles matters without a lawsuit.