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Verizon moves to control $250 billion a year in healthcare industry losses

To combat a growing problem, the U.S. government and private health insurers are tapping Verizon’s automated platform to detect and prevent fraud.

According to the U.S. Department of Health and Human Services, national health expenditures totaled $2.5 trillion in 2009. Fraud is at ten percent. Verizon Fraud Management for Healthcare is a new platform tailored to the health care industry that uses predictive modeling technology to examine health care payment requests. The platform routes potentially fraudulent claims to case managers for investigation, helping identify fraud before payments are made. This reduces improper payments and expensive "pay-and-chase" recovery operations.

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Health care fraud impacts all Americans says Dr. Peter Tippett, vice president and chief medical information officer, Verizon Connected Healthcare Solutions, but now health insurers will be “better equipped to identify fraud and abuse and begin to turn the health care cost curve.”

This is a great example of a telco extending a core skill into another industry, even though predictive analytics is relatively new to telecom itself.

The Verizon fraud-detection solution, delivered from the cloud, employs a customized version of the software platform the company uses for its own fraud prevention programs. Internally, the platform processes more than 20 billion records a day, including more than 700 million call records. By extending this service to the healthcare industry, Verizon offers a comprehensive portfolio of managed, IT and consulting services that can improve health care access and delivery, while managing costs.

As long as Verizon also gets the billing right (CP: Verizon overbills Beth Israel Hospital – or companies are customers too), then the initiative is only to be applauded.

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© 2014 Penton Media Inc.

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