PRO BTP uses IBM analytics to fight healthcare insurance fraud

IBM has formed partnership with PRO BTP, a welfare institutions in France, to deliver a platform to fight healthcare insurance fraud using analytics.

The new SOLON platform is built with IBM’s Smarter counter fraud Software and Services. It uses advanced analytics to detect fraud patterns and suspicious activity, qualify them in real time, and decide how they should be treated.

SOLON allows insurance providers to identify issues at the moment of payment for optical and dental reimbursements. As a result, PRO BTP will be able to reduce the volume of fraudulent transactions, reduce costs and improve service, IBM said.

IBM smarter_counter_fraud“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,” said PRO BTP CEO Paul Grasset. “This is the goal of the platform developed with our partner IBM which has proven expertise in fighting fraud.”

PRO BTP conducted a pilot using the platform for 21 months. It 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.

Silvano Sansoni, vice president, Industries and Business Development, IBM France, said, “This is a joint development partnership and the outcome of huge IBM investments. It supports this new idea that fraud cannot and must not be considered as a cost of doing business.”

The two companies plan to extend the SOLON platform to other medical specialties such as hospitalization, pharmacy, audiology and prosthesis benefits as well as life insurance.

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