Claims fraud in the North American Property and Casualty (P&C) insurance industry is estimated to cost billions of dollars a year. Questionable P&C claims are thought to have risen. Nationwide Mutual Insurance Company, an insurer and financial services company in the United States has selected BAE Systems Detica’s NetReveal enterprise fraud detection software for its Property and Casualty (P&C) business.
The firm says that its NetReveal networks and scores related entities and records within a company’s data to expose networks of suspicious activity that are otherwise hidden. Stephen Applebaum, Senior Analyst Property and Casualty Insurance, Aite Group said: “Historically challenged to effectively contain fraud and leverage growing amounts of data from multiple systems, insurers of all sizes are deploying sophisticated analytics solutions such as Detica NetReveal to help identify potential fraud. This allows them to allocate and prioritize valuable resources where most needed. These solutions are proving very effective at identifying fraud, which further benefits carriers and their policyholders.”
Joe Friscia, President of the Americas BAE Systems Detica said:
“Criminals are becoming more sophisticated in their approach as they test the thresholds which organizations use to protect their business. The NetReveal solution provides the ability to detect and prevent fraudulent activity at the point of policy application, as well as identifying existing networks of suspicious activity.”
Meanwhile Detica NetReveal, was selected by the Commonwealth of Massachusetts’ Executive Office of Health and Human Services to help combat Medicaid fraud and abuse and to provide prepayment screening of the Commonwealth’s Medicaid claims. The software is to help MassHealth manage cases of fraud, ensure compliance and to combat potential abuses.
The NetReveal solution will integrate with Massachusetts’ Medicaid Management Information System (MMIS) and will include public and other Commonwealth data to automatically assess risk scores associated with claims. This will let staff review, investigate and approve or deny claims; avoiding the need for costly `pay and chase` investigations. High risk cases can be referred for detailed social network analysis to help identify related patterns of serious fraud and abuse. Implementation of the NetReveal solution will be led by Dynamics Research Corporation.
The defence and security product firm says that identifying fraud and abuse related to Medicaid and Medicare, after it has happened, is difficult and expensive. Joe Friscia, President of the Americas, Detica NetReveal said: “Medicaid fraud and abuse is top of every Medicaid Program Integrity professional’s agenda. Detica NetReveal deploys advanced predictive analytics to identify suspicious patterns of behaviour, detect fraud and drastically reduce improper payments. Our technology will ensure that Massachusetts is ahead of those abusing the system, by stopping improper payments before they are made.”
