The DoT of Medical Fraud Ecosystems

The DoT of Medical Fraud Ecosystems

Recently, I attended a healthcare fraud symposium hosted by the San Bernardino County District Attorney’s Office and the Employers’ Fraud Task Force.  It was a great day and I was able to spend quality time with former colleagues and friends.

I always like to learn a couple of new things at symposiums and this was a great opportunity to do so. While listening to experts on various healthcare fraud topics, I came to a realization. Our rapidly changing world of communication and technology has created a number of ways to accurately and simultaneously identify fraudulent claims in all lines of insurance. Opening the silos of information across your business platform is the key to unlocking the “Data-of-Things” (DoT) in medical fraud ecosystems.

The Internet of Things (IoT) is a hot topic for consumers and businesses. For the insurance and risk management sectors, the IoT is most accurately expressed as the DoT. We are going to embrace the DoT with advanced analytics that can unlock patterns of behavior in medical fraud schemes, like:

  • The growing problem with compound drugs
  • The suspect business relationships with pharmacies’ medical providers
  • The individual orchestrating the schemes

Medical fraud transcends most lines of insurance (workers’ compensation, automobile, life, health, etc.).  Unlocking these various types of data in your business process will give you the ability to address this issue and increase your company’s efficiency and profitability.

The question is, are you aware of what is occurring in your book of business and can you quickly adapt to the changing and evolving fraud schemes before losing a lot of money?

Embracing and understanding advanced analytics for insurance claims process is the right step, and in the right direction.  The IoT, and the DoT, will produce valuable information for us to make better decisions. Now is the time to get ready.

Authored by:
John Standish, Chief Analytics Officer

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