eBrief | Payers Embrace Big Data

The insurance industry’s risk of loss to fraud is staggering. Just one level of upcoding can cause an insurer to lose more than $50,000 per practitioner annually. As a result, health plans are increasingly tapping into their massive data troves to identify fraudulent patterns – and pinpoint wasteful business processes.

“The data tell a story. You just have to decipher it,” says Alanna Lavelle, director of investigations at WellPoint, Inc.

Throughout this eBrief, you’ll discover how WellPoint, Aetna and other health payers are using data to drive down costs and streamlining workflows. You’ll also learn how health plans are using predictive analytics to stop fraud before it starts, thereby avoiding the frustrating and costly game of pay-and-chase.

Download this free eBrief now to learn:

  • 4 retrospective analysis techniques that foil fraud
  • How payers are using “social network analytics” to identify suspect relationship between people, businesses
  • 6 ways to comb through data retrospectively
  • Key ratios to that shine a light on fraud schemes


By providing a deep dive on timely industry issues, Fierce eBriefs are valuable educational tools. They are designed to be easily read online - but also are formatted so you can print them out and take them with you. Fierce eBriefs are assembled like a magazine, read the whole thing cover-to-cover, or pick and choose the articles that interest you most. Either way, they're a great one-stop resource.

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