FICO Insurance Fraud Manager 3.3 adds link analysis, facility model to boost detection of fraud rings and suspicious providers.
MINNEAPOLIS, Oct. 2, 2012 — /PRNewswire/ — FICO (NYSE:FICO), the leading provider of predictive analytics and decision management technology, today released the latest version of FICO® Insurance Fraud Manager, the most advanced system for detecting and preventing healthcare insurance fraud, waste and abuse. FICO® Insurance Fraud Manager 3.3 integrates link analysis with business rules and predictive analytics, and also adds a facility model for detecting fraud at a hospital or an outpatient provider.
“Fraud has always been a part of the insurance business, but the magnitude of insurance fraud today is startling,” said Russ Schreiber, who leads FICO’s insurance practice. “Experts estimate the annual cost of health care fraud, waste and abuse in the US to be upwards of $700 billion, and last May one Medicare fraud scam alone racked up $452 million. Now, with FICO Insurance Fraud Manager 3.3, insurers have a better way to fight back.”
FICO Insurance Fraud Manager 3.3 boasts the first fully integrated link analysis capability with an insurance fraud application. Insurers who previously had to configure separate link analysis tools can now save time and improve results with an easy-to-use solution preconfigured to use health care claims data. With FICO Insurance Fraud Manager 3.3, insurers can investigate organized fraud rings using the visualization capabilities of a proven link analysis tool set, and easily create displays that reveal connections between disparate claims, patients and providers.