SAS: How a Hybrid Anti-Fraud Approach Could Have Saved a Federal Health Agency More than $100 Million

The New Face of Fraud and Detection

Law enforcement experts know that professional criminal enterprises inflict more damage and losses on society than opportunistic individuals. Yet today, health care anti-fraud program managers focus primarily on detecting outliers, researching standalone fraud events, and acting on tips. This is no surprise given that most anti-fraud analytic methods are focused at the provider or claim level; very little – if any – advanced data analysis focuses on the

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