FICO, a provider of analytics and decision management technology solution, has released the latest version fraud detection solution Insurance Fraud Manager 3.2 (IFM).
The new system of IFM includes a new model that scores claims from independent diagnostic testing facilities, which provide services such as MRIs and CT scans.
By analyzing medical, pharmacy and dental claims in real time, IFM’s advanced predictive models identify fraudulent and erroneous claims before they are paid.
The latest release also features improved summary reports used as the basis of all fraud investigations, as well as further system tuning to improve detection and minimize ‘false positives’ – suspicious claims that are in fact genuine.
With FICO Insurance Fraud Manager solution instantly determines which claims to pay automatically and which to review, accelerating the review process and enabling legitimate payments within prescribed time frames.
FICO predictive models detect emerging and unknown fraud schemes that are new, sophisticated or subtle to be caught by traditional rules-based systems. Rapid detection and risk-ranked fraud scores enable payers to focus their investigative priorities to minimize losses and maximize recoveries.
Reportedly, insurance fraud, waste and abuse account for 3 to 10% of all US health care expenditure, or an estimated $78bn to $260bn annually, far more than credit card fraud or other forms of insurance fraud.