Population Health Management

Fraud Detection

Fraud is defined as any purposeful and dishonest conduct undertaken with the awareness that it may result in an unlawful benefit to the perpetrator or someone else who is similarly not entitled to the benefit.

According to statistics, fraud claims account for 15% of overall Medicare costs. Insurance corporations are the most susceptible entities as a result of these unethical behaviors. Because of this unethical behavior, insurance premiums are rising on a daily basis.

Our goal is to anticipate if a provider is possibly fraudulent or the likelihood score of that provider's fraudulent action, as well as to discover the causes behind it in order to avoid financial loss.

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