Healthcare fraud, waste and abuse costs the United States billions of dollars every year, diverting precious funds away from direct patient care. Unfortunately, current detection techniques recover a small fraction of existing—and constantly evolving—healthcare fraud.

Currently, the vast majority of big dollar fraud cases are identified by whistleblowers rather than analytics. FraudScope is changing this landscape. Powered by groundbreaking university research, FraudScope uses sophisticated innovative algorithm tuning to automatically detect fraud schemes in claims data— without requiring the input of known patterns and before claims are paid.

Fraudscope’s novel technology scans medical insurance claims

data and creates real-time profiles for each provider, provider type, beneficiary, diagnosis, service profile, and care pathway. It uses scoring analytics to rank all claims and alert analysts to the most suspicious claims, saving time and money.

Fraudscope also aggregates substantiated evidence for the fraud it detects. Because this technology is focused on patterns, it can rapidly and automatically adapt to new codes and procedures—increasingly important during a period of rapid healthcare innovation. This means our technology can and detect new fraud schemes as they emerge, in real time.

Fraudscope ensures that healthcare dollars go to real patient care and not fraud, waste, and abuse.