Detect fraudulent insurance health claims to avoid inflating healthcare expenses by reducing the number of false positives.
While healthcare providers are working hard to ensure we all have access to affordable healthcare, others try to take advantage of it. According to NHS Counter Fraud Authority, around £1.21 billion is lost to fraud in the UK, each year. This results in decreasing care quality and increasing care cost. Detecting fraudulent claims using traditional methods is time consuming, inefficient and costly. Finding effective solutions to this growing issue, has become a top priority for healthcare systems.
How can TurinTech help?
Combining their expertise with TurinTech’s technology, domain experts can quickly build models to automatically detect fraudulent claims, saving enormous amount of time to do this manually. Explanation is also provided, so investigators can understand the reason why the model flagged those claims as fraudulent, identify new patterns and outline new fraud rules. This way, any fraudulent claims can be identified before they are paid, which helps catch scammers on time and keeps cost low for patients. Furthermore, the models built are highly accurate reducing the rate of false positive/negative thus avoiding unnecessary investigation costs.
- • Augment domain experts’ capabilities: combine your domain knowledge with advanced AI to quickly and efficiently detect fraudulent claims
- • Gain hidden insights: see why the model flagged certain claims as fraudulent and find new patterns
- • Keep costs low: low rates of positive/negative means only fraudulent claims will be identified, keeping cost low by avoiding unnecessary investigations