(Image source: NICB homepage.)
The National Insurance Crime Bureau (NICB; Des Plaines, Ill.) has renewed its contract with Verisk (Jersey City, N.J.) for the third time to host and maintain the Aggregated Medical Database (AMD). The partnership has resulted in the development of the AMD’s platform to identify medical provider fraud for NICB and its member companies.
“We’re committed to delivering the highest-quality service, and our ongoing collaboration with Verisk is yet another reason NICB continues to be the thought leader when it comes to insurance fraud and theft,” comments Joe Wehrle, president and CEO of NICB. “It’s in the best interest of NICB, our members, and law enforcement partners to use medical and prescription billing data to create innovative solutions that combat medical fraud.”
Identifying suspicious behavior in provider billing offers an opportunity for property/casualty insurers to contain expenditures in claims that have a medical component.
Discovering Markers of Potential Fraud, Waste and Abuse
“Our predictive analytics are applied to the AMD’s contributory information to quickly discover markers of potential fraud, waste, and abuse in medical billing data,” comments Richard Della Rocca, president, ISO Claims Analytics, a Verisk business. “This large-scale analysis produces actionable reports that allow NICB to create MedAWARE Alerts that identify suspicious providers that may be negatively affecting their members’ claims costs.” Della Rocca added, “We’re proud of our near 50-year commitment to fighting fraud, and our partnership with NICB strengthens our efforts focused on exposing medical provider fraud.”
Through its partnership with NICB on the AMD, Verisk has developed ISO MedSentry, a predictive analytic solution that detects potential fraud, waste, and abuse across an insurer’s entire book of business.