Modern Accountability for Home Healthcare

Anthroware partnered with PCG to design and develop Careify, a self-learning platform that could detect fraud at the point of user input, adapt to unique cases, and increase accountability for staff while generating billions in savings for American taxpayers.

The Challenge

In 2020, more than 345 defendants in 51 judicial districts were charged with participating in health care fraud schemes involving more than $6 billion in alleged losses to federal health care programs. Among all provider types, Personal Care Services accounted for 47% of fraud convictions, as reported by the Dept. of Health and Human Services (2020). The Cures Act mandates that Medicaid funded Personal Care Service and Home Health service providers in all states utilize an EVV tool. To capitalize on this guaranteed and expanding market, PCG needed an EVV solution built upon the firm's longstanding expertise with provider integrity solutions that identify and guard against fraud in the Medicaid space.

Design & Development

Anthroware quickly went to work mapping workflows and user journeys, designing the system architecture, and building a multi-tenant platform that leveraged AWS to provide a stable, secure, and scalable cloud-based infrastructure.With a small agile team, Anthroware completed Android and iOS native applications designed and engineered to capture in-home health service provider data,including scheduling, GPS time and location tracking, care provider services, and a self-learning system to flag potentially fraudulent activity. In addition, Anthroware built a web application to provide a secure cloud-based interface for tracking and reporting captured data with third-party application integration.

The Outcome

Careify was piloted in Arkansas to plan and track over 10,000 in-home care visits. Real-time location and data tracking, combined with offline-first capabilities and machine-driven, intelligence-enabled in-home patient care to be improved and potentially fraudulent claims by providers to be identified early and mitigated quickly.We are proud to be a part of a solution that reduces in-home health care fraud while providing improved accountability for health care professionals and increased administrative performance for providers. All while saving American taxpayers billions of dollars every year.

"Anthroware’s ability to understand the issues, challenges, and pressures endemic to the design and implementation of this application were impressive. They were distinctly successful at identifying practical, proven solutions for overcoming development issues for which we were very grateful."

Jamin Barber
Senior Consultant & Project Manager at PCG