Our Solutions

The industry’s most innovative solution set

FraudScope’s state-of-the-art patented technology has already identified claims defrauding plans over a billion dollars

FraudScope Professional

Utilizes your professional claims data to identify providers that are engaged in fraud, waste and abuse schemes.

FraudScope Facility

Identifies facilities that are involved in waste and abuse by analyzing your facility/institutional claims.

FraudScope Pharma

Identifies providers and members that are involved in pharmacy fraud schemes. This includes opioid abuse cases where providers are taking advantage of members with addictive tendencies and members are shopping to get their opioids.

  • More cases identified

  • More fraudulent payments identified than what was identified by plan’s current solution

  • Reduction in false positives

  • Increase in investigator productivity

Give your Special Investigations Unit the tools they need to maximize results.

Built from the ground up with the SIU Team in mind, Fraudscope gives organizations the tools to quickly identify suspicious claims, collect actionable information, and collaborate across the organization to open, investigate and resolve cases quickly.

Next-generation Investigative Tools

  • Expedites the investigation process by providing immediate access to insights based on various data sources
  • Helps quickly qualify leads that result in maximum savings
  • Helps catch phantom clinics by displaying pictures of provider practice locations through the platform directly

Better Fraud Detection

  • Uses advanced technology developed at the Georgia Institute of Technology
  • Automatically identifies emerging fraud, waste and abuse in a timely manner before claims are paid
  • Prioritizes claims to ensure SIU personnel time is spent on cases that will yield maximum savings
  • Underlying AI translates risk scores into actionable information to help launch investigations

Workflow Management Supporting Collaboration

  • Manage workflow within the SIU
  • Process cases for providers and beneficiaries
  • Add notifications, reminders and comments to cases
  • Share any screen with other SIU members to enhance collaboration
  • Customize roles and permissions

Maximizing SIU Effectiveness with an AI-assisted Investigation Platform

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FraudScope Advantages

Proactive Analytics

Atomatically identifies new fraud, waste and abuse schemes as they appear.

Prioritization of Suspicious Claims

Prioritizes suspicious claims based on risk scores and dollar amounts to maximize savings.

Easier Integration

Works with existing analysis techniques and can integrate other intelligence feeds.

Prepay Detection

Provides most sophisticated intelligence and risk analysis before claims are paid.

Empowers Users

Enables fraud analysts and investigators to find better leads more frequently.

International Compatibility

Adapts to any international coding standards automatically.

Maximizing SIU Effectiveness with an AI-assisted Investigation Platform

Fill out the form below to download our whitepaper