FraudScope empowers analysts and investigators to identify fraud, waste and abuse within medical insurance claims. Healthcare billing fraud is a significant problem in the United States and it will only get worse as the information of countless medical data breach victims is leveraged by cybercriminals who monetize stolen data using schemes that include filing bogus medical claims from phantom clinics. In addition to increasing cybercriminal activity, overbilling and billing for services never rendered by unscrupulous providers is on the rise.
Accurate identification of healthcare fraud, waste and abuse presents numerous challenges due to the constantly evolving nature of the fraud landscape. FraudScope overcomes these challenges through the application of patent-pending technology developed by cybersecurity researchers at the Georgia Institute of Technology. This technology utilizes a novel, analytics-based approach that automatically identifies medical claims representing suspicious activity. Armed with this capability, FraudScope serves as a comprehensive claims investigation platform that empowers investigators and analysts to derive insights and conduct full investigations of suspect claims. Some of the unique benefits of FraudScope’s offering are as follows:
- Adaptive Analytics: Automatically identifies new fraud schemes as they appear.
- Timely Detection: Provides intelligence and risk analysis before claims are paid.
- Suspect Claims Prioritization: Enables analysts and investigators to prioritize suspicious claims based on risk scores and dollar amounts to maximize prevention.
- Case Management: Includes a user-friendly system that helps track case investigations and manage workflows.
- Easy Integration: Works with existing analysis techniques and can integrate other intelligence feeds.
- Coding Agnostic: Adapts to changes in coding terminologies and systems.
FraudScope’s award-winning solution has proven highly effective with real-world data. If you would like to schedule a demo, please contact firstname.lastname@example.org