IBM and PRO BTP's Analytics to Fight Healthcare Insurance Fraud

By CIOReview | Friday, October 17, 2014

FREMONT, CA: IBM has recently announced that it has signed a seven year agreement with PRO BTP, a primary welfare institution that fights against healthcare insurance fraud.

The new SOLON cloud business solution built with IBM's Smarter counter fraud Software and Services uses advanced analytics to detect fraud patterns and suspicious activity.

It’s the growth of electronic transactions that have paved way for fraud and abuse. For example, improper payments today represent between 5 and 7 percent of all reimbursements made today by PRO BTP. With the new SOLON platform, insurance provider can identifies issues at the moment of payment for optical and dental reimbursements.PRO BTP is thus able to reduce the volume of fraudulent transactions, reduce costs and improve service.

"It is very important for PRO BTP to ensure that membership fees are actually used to cover the needs of members and to decrease the cost of insurance," says PRO BTP CEO Paul Grasset. "This is the goal of the platform developed with our partner IBM which has proven expertise in fighting fraud."

Delivered in the cloud, the SOLON platform uses IBM's advanced analytics solutions and services to analyze millions of data points held by PRO BTP and identify and predict suspicious claims and activity in real-time across both optical and dental domains.  During a recent pilot using 21 months of PRO BTP data, the platform was able to identify suspicious activity in 9 percent of optical and 14 percent of dental insurance claims, amounting to €14 million in potential losses. This detection was achieved through the use of IBM's predictive analytics solutions and the integration of numerous sources of data.