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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

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