Health Plan of San Mateo Selects Verisk Health Solutions to Mitigate Fraud and Pay Claims Accurately

Verisk Health, a leader in data-driven healthcare solutions, today announced that Health Plan of San Mateo (HPSM), a Medicaid (MediCal) plan based in South San Francisco, selected the Verisk Health payment accuracy suite of solutions to help mitigate healthcare fraud and pay claims accurately.

HPSM will leverage those solutions to identify fraud prepayment, process claims in subsecond time, improve claim validation, and lessen overpayments. Verisk Health is a Verisk Analytics (Nasdaq:VRSK) business.

“HPSM chose Verisk Health because we trust that its knowledge base and sophisticated technology will help us quickly identify areas of risk before a problem occurs,” stated Ron Robinson, CFO of Health Plan of San Mateo. “Verisk Health understands both Medicare and Medicaid—HPSM’s two main lines of business. With Verisk Health as our trusted vendor, we’re confident that we can both improve our billing processes and prevent fraud, waste, and abuse.”

“HPSM was looking for a flexible solution that’s effective at identifying fraud, waste, and abuse and eliminating overpayments,”

said David Jackson, head of Payment Solutions at Verisk Health. “In addition, the Plan has specific needs to incorporate state Medicaid

(MediCal) payment rules. With our large California client base?and as the only vendor to incorporate state-specific Medicaid payment rules?we’re well positioned to satisfy that need. HPSM has been using our HEDIS solution since 2013, and we look forward to expanding our engagement.”

About Verisk Health

Verisk Health is transforming the business of healthcare by providing data services, analytics, and advanced technologies that answer the industry’s most complex challenges. With a focus on reducing risk across all domains of healthcare, Verisk Health’s broad solution suite is designed to help health plans, employers, providers, and other risk-bearing entities improve the quality of healthcare delivery, reduce costs, ensure appropriate revenue, pay claims accurately, and support compliance. From effective population health management, quality reporting, revenue accuracy, and chart retrieval to tackling fraud, waste, and abuse, Verisk Health is committed to answering the unique challenges of its clients. Verisk Health is a Verisk Analytics (Nasdaq:VRSK) business. For more information, please visit

About Health Plan of San Mateo

The Health Plan of San Mateo (HPSM) is a public health plan that provides health care benefits to San Mateo County’s historically underserved residents. Members of HPSM receive benefits through Medi-Cal, CareAdvantage (HMO SNP), HealthWorx, and the San Mateo County ACE Program. HPSM is governed by the San Mateo Health Commission. Members of the Commission represent community advocates, physicians, pharmacists, hospitals, and elected officials who serve on the San Mateo County Board of Supervisors. HPSM fights to make a difference in the community, to turn the vision of better health into a reality. You can learn more on the web at


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