An anti-fraud detection system

Frauds in insurance companies come with many sophisticated schemes and healthcare insurance is not an exception.

The challenge
Our client, a leading CEE insurance company suspected that some end customers abuse access to private healthcare.

The solution
deepsense.ai was tasked with analyzing data in a search for anomalies and spotting the data-marks of fraudulent transactions. With the gathered knowledge, the team developed algorithms identifying common schemes and techniques of private healthcare abuse. The schemes included excessive medical diagnostics and exploiting flaws in billing systems. The team also identified potential fraud being committed by service providers abusing their agreement with the health insurance company.

The model delivered by deepsense.ai spots suspicious activities and enables the company to reduce losses significantly.

The effect
Appointment-related losses were reduced by 65%.