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Anomalies detection
AI Service
Automated search for overtreatment in invoices from clinics - identification of unreasonably provided medical services
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Fraud detection is:
Identify concrete suspicious services. Based on European clinical pathways, standards and protocols
850+ RULES /
ALGORITHMS
+30-50 new algorithms per month in addition to customized rules based on client requirements
REGULAR
UPDATEs
User-friendly interface for claims handler, integrated to the client business process
Interface for
CLAIMS HANDLERS
Installation fee – 0. Service payments linked to the claims amount
SERVICE Pricing
MODEL
Already trained Machine learning model identifies complex patterns of fraud
MACHINE LEARNING
AI Service
Problem
Most of Insurers check only 30-40% of invoices
level of overtreatment in medical invoices
Invoices are manually checked by experts
Insurers fail to check invoices before due date
Solution
AI service that automates searching overtreatment in medical invoices and registers
Results of Fraud detection in one of Top-5 Insurance companies
Group
Amount, th rub
Number of services
% of amount
Total checked
Defects identified
of which with a high probability
221 401
223 568
100%
21 291
25 712
9,6%
6 706
9 584
3,0%
New algorythms
of which with a high probability
2 888
2 876
1,3%
367
1 077
0,2%
Old algorithms
of which with a high probability
18 403
22 836
8,3%
6 340
8 507
2,9%
Deleted algorithms
1 573
2 152
0,7%
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