Guard your constituency against waste, abuse and fraud
Public sector spending is continuously under the spotlight. Media and consumer groups are always looking for and broadcasting what they perceive as unwarranted public expenses. Under pressure, and simply in good faith, government agencies work hard to tune operations and remove excess.
But, without the best detection solutions, it’s hard to put a spotlight on, and stop, one of the worst offenders of public funds: Fraud and Abuse.
Two areas of fraud and abuse transactions in particular plague agencies: Payment card spending, and health care fraud. FICO fraud and abuse solutions protect agencies from both.
Payment card spending requires more than scrutiny to avoid waste and outright fraud. It requires sophisticated detection analytics, rules management support, and optimization technology. That’s what FICO solutions bring to the problem. At the point of the transaction, or on a daily basis, our solutions can analyze complex rules associated with spending limits, types of expenditures, and volumes of transactions to properly help government officials ascertain fraud or abuse.
We also have solutions to help detect and prevent health care fraud in government payer programs. Our technology can analyze claims looking for common red flags or fraud, waste and abuse: claims paid with insufficient documentation, payments for unapproved medical services, and payments to ineligible patients from ineligible providers. Our solutions can help save millions of taxpayer dollars annually, by recapturing payments before they’re made and eliminating the cost of collections.
With our solutions, FICO helps agencies cut out losses from fraud and abuse, and avoid public relations nightmares.
With FICO’s Fraud and Abuse Protection Solution for Payment Cards you can:
- Detect improper payments to stem excessive spending with the latest detection analytics.
- Identify fraudulent attacks that could result in millions of dollars of loss with models that learn in real time and models developed on consortium data.
- Make complex decisions based on an individual’s risk profile of suspicious cardholder behavior patterns.
- Achieve real-time fraud control with advanced predictive analytics deployed in the transaction stream to stem loss immediately.
- Identify changing fraud patterns faster and prevent more fraud losses with adaptive analytic models.
- Block risky transactions in authorizations and use case and rules management to track activities.
- Reduce losses by detecting fraud in near-real-time, with fewer false positives, before losses mount.
With FICO’s Fraud and Abuse Protection Solution for Healthcare Claims you can:
- Increase throughput and payment integrity in electronic claims processing with advanced predictive models that analyze adjudicated medical and pharmacy claims at up to real-time speeds.
- Catch complex and subtle fraud schemes using predictive models trained to spot sophisticated conspiracies small irregularities invisible to less advanced analytics.
- Focus investigative resources on the cases with the greatest financial impact, and realize higher recoveries, based on rapid detection and ranked fraud scores.
- Stop losses from accumulating by identifying suspicious patterns sooner, based on automated generation of scores on providers that indicate aberrant payment habits.
- Cut fraud management expense with tools that streamline review of suspicious claims.
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