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Ross Kaplan
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Ross Kaplan serves as Solutions Architect for Health Care Fraud at SAS, in the Fraud and Financial Crimes global practice. He supports health care fraud initiatives across the Health & Life Sciences, State and Local Government, and Federal Government verticals. Ross has been at SAS for over four years. He is an 11-year veteran in the health insurance industry, focusing on analytics in health and condition management, member retention, and provider profiling prior to specializing in health care fraud. He has assisted health plans, Federal and State and Local government agencies in defining their requirements and providing guidance in their solution advancement.
Prior to SAS, Ross served as a solutions architect at Computer Associates and Siebel Systems, working with the Fortune 1000. He has supported other industries such as Insurance, Banking, and Pharmaceutical. However, his primary focus has always been in health care, receiving training in HIPAA and having direct involvement in Siebel’s health care product development. Ross has been an expert speaker at health care fraud industry events, most recently on the topic of social network analysis (also known as link analysis).
Ross received his bachelor’s degree in Business Administration, with a concentration in Computer Information Systems (CIS) from the San Francisco State University. He also received his Master’s Degree in Statistics as well as an MBA with a concentration in Systems Analysis.
Recent Posts
The holy grail of pre-pay health care fraud
Everyone within the health care community recognizes that the traditional ‘pay-and-chase’ model for fraud cost reduction has some serious limitations. Recovery of the lost funds ... Read More
Why life cycle management matters for health care fraud analysis
Due to the rapid changes in both the health care market and more specifically the amount of fraud being committed in it, it is even ... Read More
How to use social networks to identify fraud
The term "social networking" is used quiet freely today to represent a myriad of functions. Most commonly, social networking is used in context to social ... Read More
Health care fraud is on the rise
In the health care field, the impact of fraud, waste and abuse on payers -- whether insurance companies, government agencies or self-insured employers -- is ... Read More
Larger fraud schemes means more money out the door