Our Solutions

The industry’s most innovative solution set

FraudScope’s state-of-the-art patented technology has already identified claims defrauding plans over a billion dollars

FraudScope Professional

Utilizes your professional claims data to identify providers that are engaged in fraud, waste and abuse schemes.

FraudScope Facility

Identifies facilities that are involved in waste and abuse by analyzing your facility/institutional claims.

FraudScope Pharma

Identifies providers and members that are involved in pharmacy fraud schemes. This includes opioid abuse cases where providers are taking advantage of members with addictive tendencies and members are shopping to get their opioids.

  • More cases identified

  • More fraudulent payments identified than what was identified by plan’s current solution

  • Reduction in false positives

  • Increase in investigator productivity

Give your analysts, educators and investigators the tools they need to maximize results

Built from the ground up with Network, Clinical, Payment Integrity and SIU teams in mind, Fraudscope gives health plans access to the data and tools needed to detect and act quickly on fraud, waste and abuse issues that could add up quickly.

Insight Scope

  • Easy-to-use queries to search for any claim, provider or facility
  • Self-service reports to create lists, filter, sub-total, visualize and analyze behavior over time
  • Unique behavioral insights into problematic claims and provider behavior
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Provider Scope

  • Post-pay analysis identifies outlier provider billing practices compared to their peers
  • Automated provider outreach via email with link to portal
  • Provider Self-Monitoring & Communication Portal can be co-branded and provides visual comparative coding analysis for their peers
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Fraud Scope

  • Patented AI algorithms detects new and emerging fraud schemes before they add up to big problem
  • Quickly qualifies and prioritizes claims to ensure SIU team time is spent on cases that will yield maximum savings
  • Next generation investigative tools expedite your investigation process with clear scheme explanations, automated evidence chains and integrated case management workflows
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COVID-19 FWA  Schemes Report

30 page special report on emerging COVID-19 related FWA schemes

FraudScope Advantages

Early Detection

Proactive AI automatically identifies new and emerging problems and schemes, with low false positives, before they add up to a big hit to your bottom line

Data-driven Priorities

AI prioritizes issues based on risk scores and financial impact to maximize savings.

Integrated Workflow

Helps everyone respond quickly to emerging problems and opportunities to control costs

Democratized Data Access

Easy-to-use query and reporting features make it easy for everyone to access unique insights about your claims and provider behavior

Pre-claim Education

Provider Self-Monitoring & Communication Portal shows providers how their coding practices compare to their peers so they can change their behavior and reduce future claim errors.

International Compatibility

Adapts to any international coding standards automatically.

FraudScope - FWA Vigilance During The COVID-19 Pandemic

Fill out the form below to download our detailed report on how plans can protect themselves against new fraud, waste and abuse threats due to the COVID-19 pandemic.