The module that identifies suspect behaviour in claims relating to
medical expenses reimbursement.
In recent years, the fight against healthcare corruption has intensified. Estimates from the European Healthcare Fraud and Corruption Network calculate an approximate €56 billion annual loss to Europe as a result of corruption.
The system includes a wide range of rules and automatic indicators that, together with sophisticated analysis procedures, provide an effective mechanism for detecting fraud while ensuring efficient integration of the tool into business processes. Its automated scoring allows genuine claims – which are the majority – to be handled quickly, enabling automated settlement processes and faster payments – a critical success factor in health insurance.
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