Fraudscope Fights Health Care Fraud

What’s worse than a hernia operation? Cybercriminals stealing your identity to defraud the US government by claiming you had a hernia operation.

Musheer Ahmed (above) Founder of Fraudscope, believes health care fraud is a BIG issue. Estimate range up to $272 billion annually is paid out either too much to the right people (waste and abuse) or to the wrong people (fraud).

Cybercriminals set up “phantom clinics” then use stolen identities to submit medical claims for services or items never rendered. Government agencies are measured on how quickly payments are made. “They pay first then identify if there are fraudulent claims.” Dr. Ahmed states.

FraudScope uses novel data analytics techniques to prioritize suspicious medical insurance claims for investigation to save money lost to fraud, waste and abuse. Its patent-pending technology for detecting high-risk claims was developed by researchers at the Georgia Institute of Technology. Using data obtained from the Centers for Medicare and Medicaid Services (CMS), FraudScope was able to automatically detect many recently reported high value Medicare fraud cases, which were detected with help from whistleblowers.

“Our novel Claims Intelligence technology would have detected these cases several years prior to their detection through whistleblowers.” Dr Ahmed claims.

Unlike existing analytics tools, FraudScope’s advanced technology can detect existing and evolving fraud schemes without requiring any input of known and predicted patterns of fraud. “We provide sophisticated claims intelligence before payment of claims and FraudScope can adapt to changes in diagnosis and procedure codes automatically.”

Not only does fraud harm the medical system but also it can be dangerous for an individual if fraudulent claims end up in your personal medical record.

Health Connect South always asks “What do you need?

“We’re a startup working on our business model. We’re looking for pilot partners and also potential investors” Dr Ahmed says.

To learn more about Fraudscope and ways to keep the bad guys from getting our health care dollars, please click here.

Please SAVE THE DATE September 21, 2016 for Health Connect South’s next Annual Gathering.

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