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Fraud and Abuse Diagnostic

Leverage our extensive experience in fraud and abuse management

Fraud and abuse

With the world economy in recession, healthcare payers, both government agencies and private sector firms, are under assault by fraudsters and opportunistic citizens. Investigators and program integrity staff who tackle fraud and error are taxed with the amount of leads and the types of schemes being perpetrated by recipients and vendors. Generally, these watchdog functions do not have the sufficient tools to adequately address this significant problem.

In as few as three to four weeks, IBM's Center for Business Optimization can help you address these issues.


The Fraud and Abuse Diagnostic contains a library of pre-built fraud models for major medical specialties. It will detect multiple behaviors and schemes simultaneously. The diagnostic moves the analysis from claim level to provider level. It will shorten the time to investigate and recover funds and measure fraud scientifically.

This offering can help you obtain an analysis of your highest risk areas and obtain tangible cases with detailed reasons for selection. You will benefit through:

  • Increased number and quality of cases identified for investigation
  • Reduced amount of fraud and error
  • Decreased time to investigate and recover funds

For more information or to request a conversation, call 1-800-333-6705 or e-mail IBM at

Why IBM?

The IBM Fraud and Abuse Diagnostic:

  • Uses advanced analytics and statistics, not queries
  • Contains pre-built behavior models that can be adapted in hours for a payer organization
  • Powerful analytics are presented in easy-to-understand format for investigators
  • Does NOT require users to have an advanced degree in statistics
  • Analyzes your claims data "on demand," using pre-built behavior models

For more information or to request a conversation, call 1-800-333-6705 or e-mail IBM at


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