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Spiraling health care costs have a multitude of sources, including the millions of dollars lost to fraudulent, abusive and erroneous claims, dollars that payers should never be paying at all. Annual fraud costs in the US are estimated at 3% to 10% of total health care spending. And factoring in abuse and errors, the costs rise to between $200B and $600B, annually. Given the magnitude of the problem, and today’s emphasis on operational profitability, payers can’t afford to continue absorbing dollars associated with rising fraud, abuse and errors. With FICO’s comprehensive, low cost of ownership solution, fraud, abuse and errors can be quickly and effectively eliminated today.
Detecting problematic claims before payment is a payers’ biggest arsenal, and also the most efficient. But fraud is elusive, and patterns may not emerge until after payment. FICO’s predictive analytics are powerful in fighting fraud and abuse at every stage—before, hours or days, and months or years after payment. It’s also effective at detecting billing errors and identifying systemic weaknesses and vulnerabilities like oversights in provider contracts and loopholes in benefit policies.
FICO’s industry leading fraud detection system enables payers to:
With FICO’s health care payer fraud management solutions you can:
