GEHA selects FICO Analytic Solution to intensify fight against insurance fraud, waste and abuse
FICO, provider of analytics and decision management technology, announced that the Government Employees Health Association (GEHA) has upgraded to FICO® Insurance Fraud Manager and will be adding FICO® Blaze Advisor® business rules management systems to help it more broadly and effectively detect and prevent insurance fraud, waste and abuse (FWA).
GEHA is the second-largest national health plan and the second-largest national dental plan for federal employees, retirees and family members, serving more than one million covered lives worldwide. GEHA has been a long time user of FICO analytics to analyze medical claims and fight fraud prior to payment.
With the upgrade to FICO® Insurance Fraud Manager, GEHA can not only monitor medical claims but also can manage pharmacy and dental claims with fraud detection and prevention models, discovering new fraud schemes in additional areas. GEHA also will be using FICO® Blaze Advisor® business rules to proactively evaluate claims and stop known fraud earlier in the process, driving greater efficiency and results.
“Many organizations have adopted FICO’s analytics-based solutions to address the enormously costly problem of health care fraud, waste and abuse,” said Russ Schreiber, vice president and insurance practice leader at FICO.