The Problem...
Data Overload Facilitates Fraud
High volume transaction environments are prone to fraudulent behavior because the likelihood of detection is small due to overwhelming data volume. For example, Medicare processes 4.5 million claims per day and must detect problems within 30 days or the claims are automatically paid. Automated oversight systems combined with human oversight control just can't keep up with the massive flow of information. This creates the opportunity for fraud.
Detection Model Algorithms
Data Roadmaps for Prevention
Many schemes can be detected by automated programs to search for fraudulent pattern behavior that predict a likeli-hood of fraud. The power of computing and data storage allows for a great deal of automated detection activity. However, this only goes so far.
Intuitive User Interface
Visual Analytics
The absolute key to fraud detection solutions lies in the final user interface. The investigative process must be human based. Investigators need to be able to sort through both automated detection models as well as all data sources to build fraud cases against increasingly creative criminals. The VisualCue technology provides innovative tools to empower the investigator.
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"the crime of Medicare fraud is bigger than the drug business in total volume"
-CBS, 60 Minutes, October 2009
The VisualCue Command Center Solution |