MINNEAPOLIS—March 16, 2011—FICO (NYSE:FICO), the leading provider of analytics and decision management technology, today announced the general availability of FICO™ Insurance Fraud Manager 3.2 (IFM), the latest version of the health care industry’s most advanced fraud detection solution. The system includes the industry’s first model that scores claims from independent diagnostic testing facilities, which provide services such as MRIs and CT scans.
By analyzing medical, pharmacy and dental claims in real time, FICO™ Insurance Fraud Manager’s advanced predictive models catch fraudulent and erroneous claims before they are paid, saving payers millions and minimizing the “pay and chase” syndrome. The new release also features enhanced summary reports used as the basis of all fraud investigations, as well as further system tuning to improve detection and minimize “false positives” — suspicious claims that are in fact genuine.
With FICO™ Insurance Fraud Manager, payers are no longer under pressure to pay claims without adequate fraud analysis, in order to meet deadlines or comply with regulatory requirements. The system instantly determines which claims to pay automatically and which to review, accelerating the review process and enabling legitimate payments within prescribed time frames. FICO predictive models detect emerging and unknown fraud schemes that are too new, sophisticated or subtle to be caught by traditional rules-based systems. Rapid detection and risk-ranked fraud scores enable payers to focus their investigative priorities to minimize losses and maximize recoveries.
One of the largest health care insurers in the U.S., Highmark, Inc. has experienced very positive results since implementing the IFM 3.1 release of the claims scoring solution during the second quarter of 2010. Denny Latsha, a program manager for Highmark, reported: “From May 2010 through December 2010, 336 new cases have been opened by our software evaluation team. Since implementation of the claims scoring model in May, our year-end ROI is 9 to 1.
“FICO’s IFM technology has met our corporate goal of delivering a true predictive modeling solution in our efforts to identify potential fraud, waste and abuse,” Latsha added. “We are anxious for the new 3.2 release of the IFM software. Specific features we look forward to utilizing include: creation of additional management reports, faster response time for select searches and enhancements to the delivery of provider summary information within the provider scoring model.”
Insurance fraud, waste and abuse reportedly account for 3 to 10 percent of all U.S. health care expenditure, or an estimated $78 billion to $260 billion annually, far more than credit card fraud or other forms of insurance fraud. Reducing fraud in the system, and the cost to payers and patients alike, is a major priority of health care reform.
“Our new version of IFM reflects FICO’s commitment to help solve this massive problem that affects us all,” said Russ Schreiber, vice president for insurance at FICO. “We are continually fine-tuning our solution to equip payers with the most powerful tool available for rooting out more fraud, sooner.”
FICO (NYSE:FICO) transforms business by making every decision count. FICO’s Decision Management solutions combine trusted advice, world-class analytics and innovative applications to give organizations the power to automate, improve and connect decisions across their business. Clients in 80 countries work with FICO to increase customer loyalty and profitability, cut fraud losses, manage credit risk, meet regulatory and competitive demands, and rapidly build market share. FICO also helps millions of individuals manage their credit health through the www.myFICO.com website.
Statement Concerning Forward-Looking Information
Except for historical information contained herein, the statements contained in this news release that relate to FICO or its business are forward-looking statements within the meaning of the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995. These forward-looking statements are subject to risks and uncertainties that may cause actual results to differ materially, including the success of the Company’s Decision Management strategy and reengineering plan, the maintenance of its existing relationships and ability to create new relationships with customers and key alliance partners, its ability to continue to develop new and enhanced products and services, its ability to recruit and retain key technical and managerial personnel, competition, regulatory changes applicable to the use of consumer credit and other data, the failure to realize the anticipated benefits of any acquisitions, continuing material adverse developments in global economic conditions, and other risks described from time to time in FICO’s SEC reports, including its Annual Report on Form 10-K for the year ended September 30, 2010. If any of these risks or uncertainties materializes, FICO’s results could differ materially from its expectations. FICO disclaims any intent or obligation to update these forward-looking statements.
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