NEW YORK, Nov. 16, 2011 - Building technology to help transform the health care industry, Verizon is making available to government and private health insurers throughout the U.S. an automated fraud-detection platform that will enable these organizations to better detect and prevent fraud, a growing abuse that results in more than $250 billion a year in losses.
The offering, Verizon Fraud Management for Healthcare, is an advanced-software platform tailored to the health care industry that uses predictive modeling technology to examine health care payment requests and route potentially fraudulent claims to case managers for investigation. The highly scalable platform is designed to help identify fraud before payments are made, reducing improper payments, and the administrative and legal costs associated with traditional "pay-and-chase" recovery operations.
(Note: Listen to an audio podcast on Verizon Fraud Management for Healthcare to learn more on how it can improve health care fraud detection and prevention programs.)
"Health care fraud impacts all Americans by siphoning scarce dollars away from improving patient outcomes and access to care," said Dr. Peter Tippett, vice president and chief medical information officer, Verizon Connected Healthcare Solutions. "By using the advanced technologies and analytical capabilities built into Verizon Fraud Management for Healthcare, health insurers will be better equipped to identify fraud and abuse, begin to turn the health care cost curve, and achieve one of the key objectives of U.S. health care transformation efforts."
According to the U.S. Department of Health and Human Services, in 2009, the most recent year for which statistics are available, national health expenditures totaled $2.5 trillion, representing 17.6 percent of U.S. gross domestic product. It is estimated that fraud accounts for as much as $260 billion, or at least 10 percent of the annual U.S. health care expense.
Predictive modeling is commonly used in the financial services and telecommunications industries to combat fraud. It employs advanced algorithms and analytics, including link, behavioral and statistical analysis, to monitor huge volumes of information in near real time to help identify cases of potential fraud prior to processing and payment.
The Verizon fraud-detection solution employs a customized version of the software platform the company uses for its own fraud prevention programs. The internal platform processes more than 20 billion records on a day, including more than 700 million call records.
"The current post-paid model used for health care fraud programs is highly inefficient and unsustainable," said Nancy Fabozzi, senior industry analyst - health care and life sciences IT, Frost & Sullivan. "Verizon's use of advanced software technology to evaluate and process medical claims prior to payment is indicative of the future direction of health care fraud prevention."
Verizon is creating health care IT ecosystems that empower medical professionals and transform patient care. Through its Verizon Connected Healthcare Solutions practice group, Verizon offers a comprehensive portfolio of managed, IT and consulting services aimed at enhancing health care access and delivery, and better managing costs.
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