Predictive analytics software allows healthcare organizations to root out fraud by connecting different data points to create a clearer picture of fraudulent billing patterns, according to Healthcare Dive.
The program uses graph databases that allow health payers to chart the relationship between various data points in order to identify larger fraud schemes. For example, the Centers for Medicare & Medicaid Services has used the technology to identify fraud targeting Medicare and Medicaid and the method can identify potential prescription drug abuse by tracking physician-patient relationships.
“You can’t really be effective in going after healthcare fraud without some sort of data analytics,” Louis Saccoccio CEO of the National Healthcare Anti-Fraud Association told Healthcare Dive, adding that it’s equally important that payers communicate those trends to others in the industry.
Increasingly, insurers have utilized predictive analytics software to uncover more sophisticated fraud schemes, while also implementing rules-based technology to preempt erroneous claims.
Last month, CMS reported that its predictive analytics system saved the government more than $1 billion in improper payments over the last two years.
- here's the Healthcare Dive article