MINNEAPOLIS—April 13, 2010—FICO (NYSE:FICO), the leading provider of analytics and decision management technology, today announced the general availability of FICO™ Insurance Fraud Manager 3.1. With this newest version, FICO continues to build upon and strengthen its proven solution for detecting healthcare claim fraud, abuse and errors before claims are paid, and also for identifying suspicious providers as soon as aberrant patterns emerge. The latest release offers improved predictive power to help healthcare payers avoid fraud losses while accelerating the throughput of legitimate claims.
Users of FICO Insurance Fraud Manager (IFM) report ROI ratios of as much as ten to one in averted and recovered fraud losses. Release 3.1 improves upon previous versions by expanding upon the medical and pharmacy claims analyses power to include dental claims. The 3.1 release also identifies patients who may need to be restricted to specific pharmacies and/or providers in order to prevent abuse.
Healthcare insurance fraud accounts for between three and ten percent of all healthcare insurance transactions, costing the industry — and, ultimately, consumers — an estimated $200-600 billion a year in the US alone. It is a major contributor to the high cost of healthcare.
Under regulatory pressure to process and pay claims within specific time frames, payers are often unable to detect fraud or errors until after a claim has been paid, then must expend significant resource trying to recover the payment. FICO Insurance Fraud Manager helps overcome the “pay and chase” syndrome, applying advanced predictive analytics to detect fraud earlier in the process. At the same time, it speeds the processing of good claims and helps payers comply with mandated payment timetables.
“The ability to do pre-payment scoring on a wider range of claiming entities means that payers will be able to detect more potential fraud and prevent larger losses,” said Dr. Andrea Allmon, product director at FICO. “FICO’s predictive analytics have proven far more effective than rules-based methods in early detection of sophisticated fraud schemes.”
In addition to powerful claim and provider-level detection analytics, FICO™ Insurance Fraud Manager 3.1 includes a new user interface that makes it easy for users to access and share information across the organization; a comprehensive investigative case management tool; extensive reporting and analyses with intuitive drill-downs to supporting level detail; and an evidence locker for fraud investigations.
“US health insurers have been challenged to develop intra-enterprise fraud management frameworks, but are ill-prepared to participate in a collaborative, external model of fraud management,” said Maureen O’Neil, principal research analyst, Gartner. “An integrated fraud management system is essential to conduct effective analysis, improve coordination, share information and leverage resources to gain position against healthcare fraudsters.”
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.
FICO 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 initiative, 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, 2009, and its quarterly report on Form 10-Q for the period ended December 31, 2009. 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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