According to the FBI, health care fraud costs the U.S. an estimated $80 billion a year and is a serious concern for the medical and insurance industries, as well as the legal community.  Praescient Analytics’ Analysis as a Service (A3S) team can use an advanced software platform to investigate fraudulent activity in the health care system. Tracking anomalies such as relatively minor, unnecessary, and regularly repeated lab work and similar expenses can help to weed out health care fraud.  Profitable and plausible, easy to miss illicit activities such as these are geared solely to boost the bottom line at the physician’s office.  This fraudulent activity ultimately drives up health care costs across the board.

Using a number of helpers and applications, our analysts can see fraudulent trends at an individual practice, hospital, or health care network. They can then drill down to see how physicians give out referrals to specialists for their patients. Analysts can find suspicious events that suggest possible collusion between doctors to boost each other’s business with potentially unnecessary tests and blood work.

Praescient can quickly detect patterns of activity in large scale data, which is normally extremely difficult with huge data sets. When navigating the complicated nature of health care fraud, Praescient’s A3S team can cleanly and quickly examine large data sets involved in such investigations. By integrating many different kinds of data sets into one platform, Praescient analysts can help tackle the increasing – and increasingly costly – problem of health care fraud. Stay up to date with the Ideas Blog for a video demo of our health care fraud workflow.