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IBM Fraud and Abuse Management System

Healthcare fraud and abuse raises costs, decreases profits and diverts the attention of private insurers, government programs, HMOs and other organizations that strive to provide quality care at reasonable rates. The IBM Fraud and Abuse Management System (FAMS) can help your organization combat the pervasive and persistent issue of healthcare fraud.

The advantage

IBM FAMS is a combination of software and services designed to help investigators and auditors identify and analyze suspect providers and claims.

FAMS supports a full spectrum of antifraud and abuse activity — detection, investigation, settlement and prevention — and includes tools for basic and advanced data mining, drill-down reporting, and visualization techniques.

In addition, FAMS offers an application for analyzing clinical and cost data that falls outside norms during statistical analyses — the IBM Medical Profiling System. This system is designed for medical-management, medical-informatics, provider-relations, cost-containment, disease-management and physician-profiling departments.

Benefits

  • Sort through information on tens of thousand of providers and tens of millions of claims in minutes
  • Rank providers in relation to their peers — within specific geographic regions, specialties, subspecialties and other parameters to identify providers who fall outside norms
  • Drill down into detailed information on providers’ clinical and claims practices
  • Build suspicion indices based on nearly 1,000 behavioral patterns in more than 20 specialties
  • Gain comprehensive software and services, including information systems design, architecture, consulting, implementation, project management and customization to your environment, as well as an option for ongoing support

Learn more


Need help?

Contact the Express Advantage Concierge, a team of specialists dedicated to midsized business 1-877-IBM-ACCESS (426-2223).

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