ClaimWatch℠ - Fraud and Abuse Detection
Our intelligent claim surveillance software, ClaimWatch℠, employs dynamic profiling and predictive technologies. Using all available historical information, ClaimWatch℠ is able to quickly identify complex fraud schemes, including sophisticated duplicate schemes, that previously could not be identified and uncover new and emerging schemes before claims are paid.
In a study published in the Journal of American Medical Association (JAMA)*:
- 54% of physicians reported using deception of third party payers to obtain benefits
- 39% of physicians reported exaggeration of patient’s condition, changing a diagnosis or reporting signs or symptoms that did not exist