Artificial Intelligence
Reducing health insurance claims expenditure by 20% on average, by identifying fraudulent activity.
Identifying fraud based on behaviors.
Identifying fraud based on behaviors.
Detecting fraudulent behavior and wrapping it around mathematical principals found in the more familiar “simplistic” AI that we see today is what our partner has termed Psychometric AITM.
Combining math with the behaviors derived from human neural networking and decision making processes determines what is statistically improbable and what it is fraud.
False positives are prevented by requiring evidence of fraudulent behavior to be abundantly evident through highly confident P-Values.
AI FAQs
- Self-Insured Corporations
- Health Care Systems
- Pensions, Unions
- Federal and State Governments
- TPA’s
- Airlines
- Savings are rarely less than 20% on post adjudicated claims
- Opportunity for self-insured companies to reduce claims expenditure from fraudulent activity
- Prevent the abuse of taxpayer funded programs, to alleviate financial burdens of healthcare on the government and free up resources for more productive allocation
- Combine and relate the variables which result in a stronger predictive value for chronic opioid use, thus enabling an opportunity to engage early with the employee who may need interdiction
- Safer work environment
Benefits fraud can result from the actions of plan members, service providers or both in tandem. Some fraud is not intentional. An example of intentional fraud is Plan members start submitting claims for services never provided or for ineligible products, such as getting dress shoes and billing them as orthotics. Organized Crime Rings are systemic in the Health Care Benefit platforms, because it is easy to perpetrate schemes and abuse that is easily concealed in Big Data.
Your privacy and the privacy of your Plan Participants is very important to us. All data is encrypted, so we never have access to personal data.
Cost growth in medicine is driven by multiple problems.
Fraud is a major cause, as the costs are transferred to the general population through increases in insurance premiums, provider charges and taxes.
Waste and abuse is another major cause. Many medical providers game the system by charging the absolute maximum amount insurance will allow. This drives the insurance companies to increase premiums due to the increasing provider charges.
