PRO BTP, one of France’s primary welfare institutions, has signed a seven-year agreement with IBM to fight health insurance fraud with the vendor’s new SOLON cloud business solution, built on IBM’s Smarter anti-fraud software and services. The solution uses advanced analytics to detect fraud patterns and suspicious activity, qualify them in real time and decide how to respond, according to an IBM statement.
Owing to the growth of electronic transactions, improper payments today represent between 5 and 7 percent of all reimbursements made today by PRO BTP. IBM’s new SOLON platform allows the insurance provider to identify issues at the moment of payment for optical and dental reimbursements, according to the vendor. As a result, PRO BTP will be able to reduce the volume of fraudulent transactions, reduce costs and improve service.
“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,” comments PRO BTP CEO Paul Grasset. “This is the goal of the platform developed with our partner IBM, which has proven expertise in fighting fraud.”
Delivered in the cloud, the SOLON platform uses IBM’s advanced analytics solutions and services to analyze millions of data points held by PRO BTP and identify and predict suspicious claims and activity in real-time across both optical and dental domains, according to the vendor’s account. During a recent pilot using 21 months of PRO BTP data, the platform 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, IBM reports. The vendor clarifies that this detection was achieved through the use of IBM’s predictive analytics solutions and the integration of numerous sources of data.
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.