eyeDES Customized Solutions for Health Insurance Fraud Management

Fraud and abuse are widespread and very costly in health-care systems worldwide. Fraud involves intentional deception or misrepresentation intended to result in an unauthorized benefit. An example would be billing for medical services that are not rendered. Abuse involves charging for services that are not medically necessary, do not conform to professionally recognized standards, or are unfairly priced. An example would be performing a laboratory test on large numbers of patients when only a few should have it.

Healthcare fraud cases tend to appear in the news more often than before, showing that health insurance fraud detection solutions are not being deployed or are not working effectively. Current solutions, if they exist, are often outdated and consist of old, mostly rule-based systems that cannot compete with the increasingly sophisticated techniques of the worldwide fraudsters. Health insurance organizations, both public and private, need a new approach that is efficient, accurate and scalable.

At IDES Technologies we help our customers by implementing eyeDES fraud detection solutions which are updated on a regular basis and can react quickly and rapidly to the changing insurance market environment, as well as to ever changing fraud activities, tactics and trends. eyeDES solutions are accurate, flexible, scalable and customized to the situations  of our clients.