ClarisHealth Launches A.I. Powered Healthcare Fraud Detection Solution for Health Plans
Summary
According to Mark Isbitts, vice president of program integrity for ClarisHealth, who led the project, Pareo Fraud Detection provides significant advantages over conventional tools that have been in use for decades. This traditional approach involves sifting through massive amounts of data and defining thousands of rules to detect fraud, which limits its scope of effectiveness. "Currently, the SIU deals with overwhelming numbers of false positives and manual processes and still may miss some aspects of fraudulent activity and new emerging criminal schemes,” says Isbitts. Kyle Cheek, PhD., the director of the Center for Applied Analytics and a clinical associate professor of Information and Decision Sciences at the university, has worked in various payer fraud organizations. ClarisHealth provides health plans and payers with total visibility into payment integrity operations through its proprietary advanced cost containment technology platform Pareo®.