SAS: Detect and Prevent More Fraud and Improper Payments
Posted: 12 April 2013 | Source: SAS
Improve the Quality of Alerts and Reduce False Positives by Combining Data and Analytic Techniques.
All too often, insurance companies and government programs pay claims and benefits for services that didn’t take place, on behalf of beneficiaries and claimants who either didn’t exist or never met the eligibility criteria. For example, fraudsters commonly file false claims of employment, declaring employees who don’t exist or who don’t actually work the required number of hours. Or maybe those employees do exist, but they declare that their children are attending non-existent child care programs. Auto body shops and health care providers can work in collusion with fraudsters to collect insurance payments from staged auto accidents. When investigated, the fraudulent entities can disappear and reappear under new names – and continue their ways.