Identifying Healthcare Insurance Fraud How Your Organization Can Save Millions in Unjustified Payouts
By some estimates, healthcare fraud is costing insurers upwards of $200 billion annually. But with today’s new artificial intelligence technology, detecting and preventing the following frauds could not only save your organization from costly and unjustified payouts, but could lead to more affordable healthcare, a larger pool of insured and stronger corporate profitability.
Insurance Fraud by subscriber
- Allowing an uninsured individual to utilize benefits of the true beneficiary
- Using benefits to pay for non-prescribed medications
Insurance Fraud by Providers
- Overbilling and Upcoding
- Charging for services not rendered
- Performing unnecessary procedures
- Misrepresenting non-covered treatments as a medically necessary
- Falsifying diagnoses
- Utilizing kickback schemes
- Overprescribing medications
We know what the frauds are, but can we identify them in real-time before payouts are made? The short answer is yes! The advancement of artificial intelligence and machine learning has given insurance companies a new tool in battling healthcare fraud.
Because of this, you can now Mitigate Risk, Prevent Fraud, Increase Your Pool of Insured (via lower rates) Save Tens of Millions of Dollars – or More – in Fraudulent Claims and Boost Your Organizations Bottom Line.
Simply Institute the ToolCASE Artificial Intelligence suite of anti-healthcare-fraud technologies.
ToolCASE technology is simple to use, operates in real-time and can examine millions of data points across all channels helping identify and mitigate healthcare insurance risk. We identify even the smallest anomalies almost anywhere in the healthcare system.
ToolCASE is the world’s most advanced transactional AI company. We are the health insurance industry’s preferred choice for real-time risk management and fraud detection and prevention.
Our enterprise-level advanced AI solutions are scalable, simple to use and designed specifically for the health insurance industry. The ToolCASE AI machine learning technology helps stop fraud losses at your organization.