Fraud Prevention and Detection Solution

Apatics has developed a comprehensive solution that will allow insurance investigators to analyze and collect data about the red flag medical bills, obtain comprehensive information about the medical provider like their license status, any alerts, violations, information obtained from syndicated data about the provider or the organization they work with.

All this can be done without any dependency on the IT resources. Apatics uses advanced machine learning and big data to provide both rule based red flags (more than 30 red flags) and to predict new fraud patterns.

Services

PREDICTIVE
MODELING

Analyze big data to gain predictive insights and build effective business strategies.Activate your analytics with advanced model management and analytic decision management on prem, on cloud or as hybrid.

BIG DATA
IMPLEMENTATION

Through a comprehensive set of big data services and solutions across the spectrum from big data consulting to support and managed services, we help you generate actionable insights from your big data initiatives.

SEMANTIC
ANALYTICS

GraphDB is a “semantic repository”, a database system used for storage, querying & management of structured data. Uncover deep information which would remain unknown before using semantic analysis.

HealthCare Fraud News

  • Humble Surgical Hospital in Texas has filed for bankruptcy after a federal court ordered the provider to pay Aetna $51.4 million for scamming the insurer by collecting windfall profits from having patients use out-of-network services.
  • New York State Attorney General has announced the arrest a medical supply company owner for allegedly defrauding Medicare and the state’s welfare system.
  • An Ohio physician has pleaded guilty to drug, tax and fraud charges for using his clinic to supply drugs to addicts throughout the Midwest, and for his role in schemes to evade more than $3.5 million in taxes, the Department of Justice announced.
  • A 60-year-old Indian-American physician and a well-known supporter of Khalistan movement has been sentenced to 9 years in prison for a USD 3 million healthcare fraud scheme in the US in which he filed claims for procedures that were never performed