GIVE YOUR SPECIAL INVESTIGATIONS UNIT THE TOOLS THEY NEED TO MAXIMIZE RESULTS.

Built from the ground up with the SIU team in mind, FraudScope gives organizations the tools to quickly identify suspicious claims, collect actionable information, and collaborate across the organization to open, investigate, and resolve cases quickly

Next-generation Investigative Tools

  • Expedites the investigation process by providing immediate access to insights based on various data sources
  • Helps quickly qualify leads that result in maximum savings
  • Helps catch phantom clinics by displaying pictures of provider practice locations through the platform directly

Better Fraud Detection

  • Uses advanced technology developed at the Georgia Institute of Technology
  • Automatically identifies emerging fraud, waste and abuse in a timely manner before claims are paid
  • Prioritizes claims to ensure SIU personnel time is spent on cases that will yield maximum savings
  • Underlying AI translates risk scores into actionable information to help launch investigations

Workflow Management Supporting Collaboration

  • Manage workflow within the SIU
  • Process cases for providers and beneficiaries
  • Add notifications, reminders and comments to cases
  • Share any screen with other SIU members to enhance collaboration
  • Customize roles and permissions
FRAUDSCOPE HAS ALREADY IDENTIFIED CLAIMS DEFRAUDING PLANS OVER A BILLION DOLLARS, THEREBY PROVING ITS EFFECTIVENESS.

FRAUDSCOPE BENEFITS:

Proactive Analytics

Automatically identifies new fraud, waste and abuse schemes as they appear.

Earlier Detection

Provides intelligence and risk analysis before claims are paid.

Prioritization of Suspicious Claims

Prioritizes suspicious claims based on risk scores and dollar amounts to maximize savings.

Empowers Users

Enables fraud analysts and investigators to find better leads more frequently.

Easier Integration

Works with existing analysis techniques and can integrate other intelligence feeds.

Coding Agnostic

Adapts to changes in coding terminologies and international coding systems.

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