Data mining, rules-based tools, neural networking, predictive modeling, case management systems ... such is the growing smorgasbord of technologies that Pittsburgh-based Highmark Inc. is implementing to reduce fraud. Working with the Minneapolis, Minn.-based Fair Isaac Corp., the independent licensee of the Blue Cross and Blue Shield Association developed a fraud analytical tool, and is now running reports and doing data extraction in minutes and, sometimes, seconds rather than in hours, days or even weeks. The health insurer also implemented a post-pay solution from Fair Isaac that quickly ranked 21,000 providers, enabling Highmark to uncover a significant number of new cases of fraud. Furthermore, in the past year it has referred $9 million worth of fraud cases to law enforcement.
Highmark is eager to test a new pre-pay solution, given that it may only recover 20% to 30% of the funds in post-pay since the indebted entities have often squandered the assets, according to Tom Brennan, director of special investigations for Highmark.
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