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STAYING AHEAD IN THE HEALTH INSURANCE FRAUD GAME

Excessive usage and over-utilization of healthcare insurance manifests in various forms of fraud and abuse practices, making the delicate task of balancing healthcare quality and the cost burden of care delivery while regulating access to healthcare services a daunting exercise. Learn how we applied AI to understand early signs of fraud, detect patterns of misuse by members (and providers) and predict the likelihood of a fraud before they happen. At the end, a new and effective approach to fraud management was crafted, one that departs from conventional tools (e.g., random auditing or whistle -blower tips) and embraces data-driven methodologies.
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