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 the SIU Team in mind, Fraudscope gives organizations the tools to quickly identify suspicious claims, collect actionable information, and collaborate across the organization to open, investigate and resolve cases quickly.
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Atomatically identifies new fraud, waste and abuse schemes as they appear.
Prioritizes suspicious claims based on risk scores and dollar amounts to maximize savings.
Works with existing analysis techniques and can integrate other intelligence feeds.
Provides most sophisticated intelligence and risk analysis before claims are paid.
Enables fraud analysts and investigators to find better leads more frequently.
Adapts to any international coding standards automatically.