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What is Health Care Benefits Fraud?
Benefits fraud can result from the actions of plan members, service providers or both in tandem. Some fraud is not intentional. An example of intentional fraud is Plan members start submitting claims for services never provided or for ineligible products, such as getting dress shoes and billing them as orthotics. Organized Crime Rings are systemic in the Health Care Benefit platforms, because it is easy to perpetrate schemes and abuse that is easily concealed in Big Data.
How much does healthcare fraud cost the United States and Canada each year?
Post Paid Benefits Fraud cost the United States and Canada, an estimated $350,000,000,000 per year. Three Hundred and Fifty Billion dollars a year.
What is M42?
M42 is a groundbreaking, mathematical system for detecting and neutralizing fraudulent schemes and activities. M42 is a patented SaaS platform that utilizes Artificial Narrow Intelligence Machine Learning, and Neural Networks Analytics. The solution involves finding patterns in data that are historical indicators or predictors of fraud.
M42 assists in the deciphering of indicators in data.
M42 has developed a unique process that prevents fraud by utilizing: • Two U.S. Patents for understanding critical decision making • artificial intelligence • advanced statistical analysis -machine learning.
What problem does M42 solve?
Adequate controls to monitor the health care industry for the prevention of fraud do not exist.
It is often against the interest of the insurance companies to check for fraud because it reduces Premiums revenue.
Who needs M42?
Self-Insured Corporations, Health Care Systems, Pensions, Unions, Federal and State Governments, TPA’s, Airlines.
What are the expected benefits?
Opportunity for self-insured companies to reduce claims expenditure from fraudulent activity.
Prevent the abuse of taxpayer funded programs, to alleviate financial burdens of healthcare on the government and free up resources for more productive allocation.
M42 can combine and relate the variables which result in a stronger predictive value for chronic opioid use, thus enabling an opportunity to engage early with the employee who may need interdiction.
Based on empirical evidence, we anticipate the annual claims cost to savings for our client’s would indicate an ROI of 10:1.
Safer work environment.
The Benefit to Cost Ratio is 100 : 1.
M42 is a subscription service for the continuous monitoring of the subscribers during your contract, and after the initial audit.
Have more questions? Fill out the contact form below to ask your question or request a Demo!
M42 is a Software as a Service (Saas) platform that empowers its users through specialized AI and ML technology to identify difficult to find insights.