Feature

Healthcare

Detect and Disrupt Healthcare Fraud

Healthcare fraud is conducted by a variety of perpetrators and in a number of ways, creating complex layers of transactional data. As a result, investigators and analysts must analyze tremendous volumes of disparate data that is often stored in multiple sources to uncover fraudulent activity.

IBM i2 solutions will help you quickly organize and consolidate data from various sources, identify trends, and actively track illicit operations. With IBM i2 you can efficiently differentiate legitimate claims from fraudulent ones.

Key Features:

  • Identify common connections between providers and beneficiaries
  • Identify physical address and legal relationships between entities that may be phantom providers
  • View frequency and type of healthcare transactions as histograms and heat maps which can identify potential fraud
  • Set up transaction alerting and triggers which point out claim and new policy fraud
  • Perform predictive analysis on specialty data such as pharmacy logs
  • Quickly differentiate between individual fraudsters and organized fraud rings
 




 

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