FraudScope’s state-of-the-art patented technology has already identified claims defrauding plans over a billion dollars
Utilizes your professional claims data to identify providers that are engaged in fraud, waste and abuse schemes.
Identifies facilities that are involved in waste and abuse by analyzing your facility/institutional claims.
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
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.
30 page special report on emerging COVID-19 related FWA schemes
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
AI prioritizes issues based on risk scores and financial impact to maximize savings.
Helps everyone respond quickly to emerging problems and opportunities to control costs
Easy-to-use query and reporting features make it easy for everyone to access unique insights about your claims and provider behavior
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.
Adapts to any international coding standards automatically.