Verizon has launched an automated fraud-detection platform that will enable
government and private health insurers throughout the U.S. to better detect and
prevent fraud, a growing abuse that results in more than $250 billion a year in
The offering, Verizon Fraud Management for Healthcare, is an advanced-software
platform tailored to the health care industry that uses predictive modeling
technology to examine health care payment requests and route potentially
fraudulent claims to case managers for investigation.
The scalable platform is designed to help identify fraud before payments are
made, reducing improper payments, and the administrative and legal costs associated
with traditional pay-and-chase recovery operations.
“Health care fraud impacts all Americans by siphoning scarce dollars away
from improving patient outcomes and access to care,” said Peter Tippett,
vice president and chief medical information officer, Verizon Connected Healthcare Solutions.
In 2009, the most recent year for which statistics are available, national
health expenditures totaled $2.5 trillion, representing 17.6 percent of U.S.
gross domestic product. It is estimated that fraud accounts for as much
as $260 billion, or at least 10 percent of the annual U.S. health care expense,
according to the U.S. Department of Health and Human Services.
Predictive modeling is commonly used in the financial services and
telecommunications industries to combat fraud. It employs advanced
algorithms and analytics, including link, behavioral and statistical analysis,
to monitor huge volumes of information in near real time to help identify cases
of potential fraud prior to processing and payment.
The Verizon fraud-detection solution employs a customized version of the
software platform the company uses for its own fraud prevention programs.
The internal platform processes more than 20 billion records on a day,
including more than 700 million call records.
By Telecomlead Team