The technology uses predictive analytics to find and flag statistical anomalies in claims sent to payers, allowing insurance companies to investigate potentially fraudulent claims before payment is made.
“Our research shows that somewhere between $125 billion and $175 billion is spent every year on fraudulent health insurance claims in the U.S.,” said Mike Boswood, Truven Health Analytics’ president and CEO, in the news release. “We have built an enormously successful practice helping healthcare payers identify and reclaim much of those funds through our statistical modeling capabilities, and the next frontier is preventing the problem altogether. By leveraging Fortel’s groundbreaking predictive analytics technology, we are bringing more powerful, reliable pre-payment fraud solutions to the healthcare industry.”
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