Network Analysis – Detection of Fraud, Waste & Abuse: Large Insurance Plan
FTI Consulting was hired by a client to assist with the detection and quantification of fraud, waste and abuse related to a large self-insured health plan. Our review focused on the Insurance Plan’s medical claims associated with over 60,000 employees, 200,000 medical providers, $2.5 billion in expenditures, over a seven year evaluation window. We were able to assist the client in detecting individual patients and medical providers that were likely perpetrators of fraud, waste and abuse. This was done by integrating the Plan’s traditional fraud detection and internal audit procedures with advanced statistical and network analysis.