FraudScope aims to put more of our healthcare dollars towards patient care by reducing billing claims fraud. Such fraud costs the nation an estimated $272 billion annually, of which up to 95% is missed by current detection techniques. FraudScope uses novel data analytics techniques to prioritize suspicious medical insurance claims for investigation to save money lost to fraud, waste and abuse. Its patent-pending technology for detecting high-risk claims was developed by researchers at the Georgia Institute of Technology. Using data obtained from the Centers for Medicare and Medicaid Services (CMS), FraudScope was able to automatically detect many recently reported high value Medicare fraud cases, which were detected with help from whistleblowers. Our novel Claims Intelligence technology would have detected these cases almost three years prior to their detection through whistleblowers.
Unlike existing analytics tools, FraudScope’s advanced technology can detect existing and evolving fraud schemes without requiring any input of known and predicted patterns of fraud. We provide sophisticated claims intelligence before payment of claims and FraudScope can adapt to changes in diagnosis and procedure codes automatically.