i-Sight Case Management Software Strengthens Enforcement at Workers Compensation Commission
The West Virginia Workers’ Compensation Commissions Office of Inspector General has selected the i-Sight case management software as part of a broad strategy to combat fraud against the workers’ compensation system. The i-Sight case management software will strengthen the commission’s enforcement capabilities in three ways: • By enabling staff at the commission to more effectively track and manage cases involving suspected fraud and abuse; • By making it easier for state employees and other citizens to report cases of suspected fraud and abuse; • And by enabling Workers’ Compensation Commission investigators to more easily analyze and detect patterns of suspicious behavior on the part of claimants, employers and medical vendors.
OTTAWA, Canada (PRWEB) October 1, 2004 – Customer
Expressions, a leading provider of case management software, complaint
tracking system and corrective action (CAPA) management solutions, today
announced that the West Virginia Workers’ Compensation Commissions Office of
Inspector General has selected the i-Sight case management software as part of a broad strategy
to combat fraud against the workers’ compensation system.
“By
implementing the i-Sight case management solution, Greg Burton, Executive
Director for the Workers’ Compensation Commission is letting our customers know
that he is deadly serious and committed to stopping fraud and abuse within the
Commission,” said Christopher A. Bailes, Director of Operations for the Workers’
Compensation Commission’s Office of Inspector General.
The i-Sight case management software will strengthen the
commission’s enforcement capabilities in three ways:
• By enabling staff
at the commission to more effectively track and manage cases involving suspected
fraud and abuse;
• By making it easier for state employees and other citizens
to report cases of suspected fraud and abuse;
• And by enabling Workers’
Compensation Commission investigators to more easily analyze and detect patterns
of suspicious behavior on the part of claimants, employers and medical
vendors;
According to Bailes, “The i-Sight case management
software will allow us to manage our system, our people and our performance
much more effectively than ever before.”
The Challenge:
In 2003, the
State of West Virginia launched a major reform of its workers’ compensation
system, which was then heavily in debt and losing close to $1 million a day. A
key goal of the initiative was to reduce the incidence of fraud and abuse. West
Virginia stepped up enforcement and by ensuring greater coordination among the
state officials who were responsible for overseeing the system. Previously, the
enforcement role was divided among staff in three separate offices – an
investigations unit, a legal unit and a special projects unit. Under new
legislation passed in July 2003, all three offices were combined to form a
single Office of the Inspector General (OIG) within the Workers’ Compensation
Commission.
Merging the three groups, however, was only the first step.
“In the past, each office had its own separate system of reporting, which meant
there were a lot of communication problems,” said Chris Bailes, the OIG’s
Director of Operations. Indeed, Bailes said that under the old system, there was
some reluctance to report suspected cases of abuse because of the slow pace of
the enforcement process and by the lack of feedback related to ongoing
investigations. “We realized that when we brought all these people together,
getting quality reports and being consistent was going to be a challenge,”
Bailes said. “We knew that to succeed, we had to have a proper case management
system.”
The Solution:
The Office of Inspector General evaluated a
variety of case management solutions before choosing i-Sight from Customer
Expressions. Two factors in particular drove the decision. “First, we found
that the reporting features within i-Sight were excellent,” Bailes said. “That is really key,
because without good data we can’t make good decisions. And second, we
appreciated the flexibility that i-Sight gave us. We liked the fact that if we wanted to change
our internal procedures six months down the road, i-Sight would allow us to do that.”
One of the many
benefits of the new system is that it is now much easier for citizens and state
government employees to report suspected cases of fraud and abuse. If they wish,
they can call a toll-free number and speak to a Workers’ Compensation Commission
staff member, who will enter the information into the system. Alternatively,
members of the public can visit the Commission’s website and submit the
information themselves via a secure, customized web form. The system includes a
series of built-in prompts to reduce the possibility of incomplete reports and
ensure more effective enforcement.
Once submitted, each report of
suspected fraud or abuse is routed automatically to a staff member who is
qualified to decide whether the situation warrants further action. When
appropriate, the case is assigned to a team consisting of a research analyst,
investigator, and prosecutor. At each stage in the enforcement process, i-Sight ensures that all relevant officials are kept fully
informed and can easily record their activities and the time spent working on
the case. As various workflow milestones are reached, the i-Sight system also automatically generates template letters
and emails to relevant recipients. For example, the person who originally
submitted the tip can, if he or she wishes, receive regular email updates at
30-day intervals.
“We need to know where every one of our cases is in our
system, in what unit and at what stage of prosecution,” Bailes said. “The i-Sight software gives our managers the tools to manage their
caseloads effectively.” At the same time, the reporting tools within i-Sight will make it easier for staff to analyze data and
detect patterns of fraud and abuse that might otherwise have gone unnoticed.
That, combined with the ease with which state employees and members of the
public can now report suspected cases of fraud and abuse, creates a powerful
deterrent for anyone who might be thinking of committing fraudulent of abusive
behavior. “The i-Sight case management system is helping us to increase
public awareness of the Office of Inspector General,” Bailes said. “If someone
is doing something wrong, we want them to know that we’re looking at them, and
we want them to be very nervous about it.”
Yet another benefit is that,
for the first time, the Office of Inspector General now has a convenient way of
tracking and monitoring court-ordered restitution and repayments. “We have over
$6 million dollars in restitution and repayment agreements, and to date a little
over 10 per cent of that has been paid,” Bailes said. “We needed a way to
monitor that situation the same way a bank monitors its loan repayments, with
automatic alerts when people are missing their payments. The i-Sight case
management software does that for us, and it’s a fantastic
feature.”
Bailes is clearly impressed by the professionalism of the team
at Customer Expressions. “The implementation and launch of the i-Sight case management software has been very smooth – much
easier than I have experienced with other software implementations. And the
technical staff at Customer Expressions
is one of the most responsive groups I have ever worked with. They’ve been right
on top of everything – just gems to work with.”
About Customer
Expressions
Based in Ottawa, Canada, Customer Expressions (http://www.customerexpressions.com) is a leading provider of
web-based complaint tracking software and case management systems for regulators
and enterprises focused on quality assurance and customer service. Customer
Expressions has gained an international reputation for best-in-class case
management software that enables managers to improve customer retention and
profitability. The privately held firm provides i-Sight, an integrated solution
for complaint tracking, corrective and preventive action management (CAPA
Management), compliance monitoring and other business processes that require
case management.
For further information, please contact:
Joe Gerard,
Vice-President, Sales & Marketing
800-465-6089 or e-mail protected from
spam bots
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Source : http://www.prweb.com/releases/2004/10/prweb163360.htm