City of Fort Worth saves $1.7 million in fraud by removing suspect pharmacies from its health plan

FORT WORTH, TX – In its work to reduce the cost of employee health care claims, the City of Fort Worth has excluded 24 suspect pharmacies from billing its plan, preventing $1.7 million in fraudulent payments to date, without member disruption.

For several years, Fort Worth officials have worked with SmartLight Analytics to find and remediate wasteful spending in its self-funded healthcare plan. In 2020, analysts added reviewing pharmacy claims and found suspect billing in this data, too.

“The patterns indicating abusive billing were clear. In one scheme, members were being prescribed broadly available creams and ointments by physicians that they hadn’t seen, and the prescriptions were filled at pharmacies hundreds of miles away from their home,” said Asha George, CEO and co-founder of SmartLight Analytics.

Working with Fort Worth’s pharmacy benefits manager (PBM), a plan was developed to address pharmacies where clear abusive patterns were noted in the data. The City has now suspended claims to 24 suspect pharmacies preventing an estimated $1.7 in fraudulent payments. It should be noted that the findings and actions were not disruptive for city employees. To date, not one employee complaint has been received, further confirming that employees were not aware these prescriptions were being filled under their pharmacy benefits. 

“Whenever we find waste, fraud, or abuse for obvious reasons, we want to stop that as quickly as possible,” said Nathan Gregory, HR Director for the City of Fort Worth. “Everything we do within our health fund, we do with an awareness that ultimately, we are dealing with taxpayer funds. It’s our responsibility to provide good benefits to our employees but also in a sustainable manner so that our health plan is sustainable in the long-term.” 

“We have been working with the City of Fort Worth to reduce its healthcare plan costs by regularly reviewing claims looking for fraud, waste or abuse that is adding to the City’s costs,” George said. “Since 2020, we’ve been able to return $3.5 million in savings back to the City’s plan from all of the medical and pharmacy overpayments.”  

To read a full paper on the Fort Wort pharmacy findings, click here. 

SmartLight Analytics combines the best inferential analytic models with a team of health insurance data and clinical experts to find fraud, waste, and abuse in self-funded employer healthcare plan claims data. SmartLight Analytics works with large employers to help them reduce healthcare spending by identifying and mitigating waste in claims. The process used by SmartLight Analytics uses proprietary models as well as clinical and investigative teams to minimize false positives. The team presents highly confident results and works directly with carriers to remediate costs.

Real estate company uses flat fee to save millions for homeowners AND grow business

NASHVILLE, TN — Several unexpected events disrupted the real estate industry in Nashville this year including tornadoes and COVID-19 but the growing trend of flat fee realtor services is disrupting the way people sell their homes forever.

A year ago, Jonathan Harris, founder of Scout Realty, began working with an elderly couple who needed to sell their property and recoup as much equity as possible. He tested an idea of charging a flat fee for his real estate services instead of charging the standard 6% commission. This would help the couple keep more of the equity they built up themselves over the years. Harris did not change his service model, just what he was charging for it. The idea worked well, so he offered a flat fee to more clients and business volume increased as a result. This May, Scout Realty launched the flat fee model as a standard for the company and is working toward expanding regionally.

 “We have a vision that by the end of 2025 we will have served 10,000 families and saved them $100 million in equity.”  

Jonathan Harris, Scout Realty Founder

“It is a disruption inside the real estate industry,” Harris said of the flat fee. “It threatens how real estate agents have traditionally made their money. But it gives homeowners the opportunity to benefit more from the sweat equity they have put into their homes.”

“This is needed in our community now more than ever,” he added. “Homeowners need to keep more of their equity and get more of their own money out of their homes.”

The idea is not new, Harris said. It is commonplace in developed countries outside of the U.S. But inside the U.S., the model is not popular with real estate agents because it runs against the traditional commission formula which generally charges homeowners 6% of their total home sale. Using a fee model (Scout charges a basic fee of $5,000) Harris estimates he has saved clients $2.8 million in commission charges since the beginning of 2020.

“What gives meaning to this way of doing business for us is the stories we are hearing from our clients,” Harris said. “One homeowner saved more than $18,000 using our fee system instead of a traditional 6% commission and used the money to pay for his daughter’s wedding. Another client told us they used the money to make their last tuition payment to the University of Tennessee and another paid off their minivan.”

The Suggs family worked with Scout and saved $64,412 using the flat fee model instead of a 6% commission. “That pays for a lifetime of travel baseball for our kids,” the family said.

Harris said he sees the fee model as the future of real estate because it more evenly distributes the equity in a home. But he has gotten pushback on the idea from other agencies and realtors. Yet, his team of agents have seen their book of business steadily increase and that is proving his point.

“It’s given us a renewed sense of purpose and made a tangible difference in our business,” he said. “We’ve made up the monetary difference (when calculating revenue that would have been generated under the commission model) and a whole lot more. We are winning new clients every day.”

“For me, it is an act of fiduciary responsibility. At Scout, our focus is people over profits,” Harris said, adding that Scout Realty is currently working with several interested parties throughout the United States to replicate the model.

“Clients felt like their hard-earned equity was eroded away during a sale and I started to see a better way to do business,” he said. “You have to be willing to go down to go up. So, in the short term, as an agent, you make less, but we’ve come out on the other side of that and it’s a good side.”

City of Fort Worth and SmartLight Analytics Form Partnership to Reduce Healthcare Costs

FORT WORTH, TX, December 11, 2019 – The City of Fort Worth recently partnered with healthcare cost-reduction experts, SmartLight Analytics, in an innovative effort to alleviate the rising costs of employee healthcare. An initial analysis of employee healthcare claims from the previous two years showed that the ongoing partnership could save millions for the City over the next few years.

Given the estimate that 1 in 3 healthcare dollars in the US are spent on fraud, waste, or abuse, the City of Fort Worth was eager to find an independent partner with the required expertise to reduce unnecessary costs for employees, retirees, and taxpayers. The City of Fort Worth Human Resources department engaged SmartLight Analytics to review a subset of past paid claims in a pilot program. Initial findings showed that an ongoing partnership would give the City additional tools to continue to proactively fight against wasteful healthcare spending and decrease its overall healthcare costs. 

SmartLight CEO, Asha George, said its “singular objective is to meaningfully reduce the City of Fort Worth’s per member per month (PMPM) cost by identifying and removing wasteful spending from its annual health plan dollars.”

“The intended outcome of this examination was to report significant findings to Fort Worth on its health plan spend and also provide solutions for reducing potential wasteful spend in future payments,” SmartLight stated in its first report to the City.

Some examples of what SmartLight Analytics was able to identify include:

  • pass-through billing schemes where unscrupulous physicians route lab services to out-of-network labs who in turn send the claims to in-network rural hospitals in order to receive a higher reimbursement due to their remote location, or
  • medically unnecessary abusive urine drug screening and genetic testing claims, or
  • identifying claims submitted that violate the anti-kickback laws, or
  • overuse of emergency rooms.

Given the success of the initial engagement, SmartLight Analytics will now enter into an on-going partnership with the City. Once a wasteful claim is identified, SmartLight will pass that information on to the City’s current medical and prescription providers and work with them to get the money back for the City. Additionally, the medical or prescription providers may report these findings to authorities to help curb the abuse throughout the healthcare system. SmartLight Analytics anticipates the City could save up to $2-$3 million per year in reduced wasteful claim costs.

“We anticipate that SmartLight Analytics will identify claims with fraud, waste, or abuse.  Then, they will work with our claims administrator to recover the costs for the City, and have them credited back to us,” said Brian

Dickerson, Fort Worth’s Human Resources Director. “This will be a win for our employees, our retirees, and the taxpayers of the City of Fort Worth.”

SmartLight Analytics provides a comprehensive solution to effectively reduce health care spend through proven methods developed over decades of focused experience. The City of Fort Worth engaged the firm to further reduce spending and save taxpayer dollars. The SmartLight Analytics clinical team led by board-certified physicians reviewed the claims that were identified as either being unnecessary, duplicates, or billing errors that are costing the City unnecessary dollars. The initial report was generated using statistical models and showed the City of Fort Worth exactly where there were issues. On a go forward basis, through their data analytics and clinical expertise, SmartLight will work with the City’s insurance carrier to eliminate future wasteful claims. 

The partnership will provide the City with significant savings.


Dr. Kim Stephens becomes second Project Alive president

Dr. Kim Stephens became just the second president of Project Alive this week, taking the reins from founding president, Melissa Hogan, who will continue as a board member and focus her efforts on the research side of finding a cure for the rare disease Hunter Syndrome. 

Stephens, who lives in Knoxville, Tenn., brings a tremendous amount of expertise and knowledge to this role, as well as energy and passion. She steps into the position as Project Alive is just $230,000 away from meeting its goal to fund a gene therapy clinical trial for Hunter Syndrome. The organization has raised a total of $2,268,820 and funded the preclinical work and vector manufacturing for the trial set to be conducted at Nationwide Children’s Hospital in Columbus, Ohio.

Stephens previously worked as Director of Fundraising for the National Multiple Sclerosis Society. In addition, she brings substantial business experience, having worked for IBM for 20 years in communications, product development for the IBM Accessibility Center, and most recently as the diversity and inclusion communications and education leader. Stephens received her doctorate in business from Georgia State University and focused her research on implicit bias and the role of social identity on behavioral change. She is the founder of Inclusive Thinking – a consulting company dedicated to increasing diversity and inclusion through research, education, and strategic planning. In addition, she is an associate professor at Lincoln Memorial University teaching management and leadership in the MBA program.

She will work with Mario Estevez, vice president of Project Alive, to continue the non-profit’s mission.  Stephens’ son Cole was diagnosed with Hunter Syndrome, a rare and fatal disease that mainly affects boys, in 2012 at two and a half years old.

“We are thrilled that Kim is bringing her diverse set of skills to work for Project Alive. But most of all we are excited about the passion she has for our Hunter Syndrome family,” said Founder and Past President Melissa Hogan of Thompson’s Station, TN. “She is deeply dedicated to finding more promising treatments and a cure for our boys.”

With Stephens stepping into the role of president, Melissa Hogan will retain her role as founder and board member, now focusing more intently on the research side. Hogan’s experience with clinical trials and neurocognitive endpoints, as well as her work with the FDA as a patient representative and on the FDA/CTTI Patient Engagement Collaborative, will inform her efforts on patient outcomes in Hunter Syndrome. Insights from patient outcomes will be a tremendous asset to the Hunter Syndrome community considering promising research like gene therapy, gene editing and other treatments.

Project Alive is poised to serve the Hunter Syndrome community by continuing to fund and design research, assist industry in the space, and bring new insights into the scientific community about this rare disease. Project Alive continues to work closely with the National MPS Society and the other Hunter Syndrome groups with the goal of saving and improving the lives of those affected by the disease.   Project Alive is a non-profit organization dedicated to finding a cure for Hunter Syndrome (Mucopolysaccharidosis II) through research and advocacy. It is a powerful voice for children and adults with Hunter Syndrome, bringing together families and advocates with researchers, industry, and regulators. Project Alive funds promising curative research, assists researchers and industry with designing research studies for our community, and advocates for the most effective and efficient system of clinical research, evaluation, and approval. Through its innovative campaigns and grassroots efforts, Project Alive has made significant advances in public awareness about Hunter Syndrome and its symptoms, the need for early diagnosis, and available treatments and clinical trials.        

Value responsiveness

Do you value responsiveness?

Do you consider responsiveness a value?

Is it important to you that someone with whom you have a personal or business connection is “quick to respond or react appropriately or sympathetically”?

It may seem out of line with values such as integrity, respect, honesty and responsibility but responsiveness is a tremendously important value that seems to be slipping away from many in both the personal and business world. Responsiveness may be corroding, in part, because of the technology that on the surface seems to help us stay better connected. However, the blame cannot be all technology’s because responsiveness is a human value not an algorithm.

We all get emails, texts and (sometimes) letters and phone calls daily. They can pile up, especially if you’re running a business or a school or an organization large or small. However, not responding to these messages sends a message whether you intend it to or not.

“If someone walked up to you and asked you a question, would you turn around and walk away from them without responding? Would you ever do that to someone?” asked Shana Rossi, director of admissions at Padua Academy and consultant with Partners in Mission. Yet, not responding to emails, texts and phone calls does essentially that. It turns around and walks away from someone without a word.

Continue reading “Value responsiveness”

Caution: sign ahead

Communicating through pictures —  and, more specifically, signs — can be a powerful way to send a message.

My daughter commented the other day that on our rural street there are not many signs. No bent arrows indicating sharp curves ahead. No speed limit indicators. Nothing telling you to “keep right” or “yield.” There is, however, a sign with a picture of a cow. Below it is another sign that reads “loose gravel.”

Loose gravel and cows ahead

Clearly there could be cows ahead, and the road is covered with loose gravel instead of smooth pavement. I live on this road and it makes for interesting travel (and running), but I digress.

I’ve started to notice these types of signs popping up in more locations. Using just color and a simple black silhouette picture, the signs communicate a message. They also tell a story.

In my commute from country to city, two signs I pass tell the story of a journey. There is this:

Tractor warning

And then this, about 35 miles away:


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Communicating well

Remembering some old rules of writing that still apply.

“But with so many words having many meanings communication can be a bit precarious.” Someone left that comment on the Two Roads Communications Facebook page. It’s true. Communication is precarious.

To communicate well is not easy. Look around: There is a lot of lousy communication. To communicate well, one must transfer an idea clearly from a thought into words (or pictures or other forms of art) that others understand. That can be tricky, because we all interpret things differently.

My husband and I have both worked in the communications field. We joke that we communicate well with everyone but each other. Emotion has a lot to do with communication among loved ones. But in business, taking excessive emotion and subjectivity out of communication can improve its clarity. Professional communications therefore strive to create messages that can be clearly understood by all.

Writing should be provocative, creative and concise. It can be those things and still be simple. Be understood clearly. Be done well.

Continue reading “Communicating well”