Combating healthcare insurance fraud

Presentation and interview by Kiril Milev

An analysis proves it: Our RiSIC product could save millions in the healthcare industry. The risk classification system, based on artificial intelligence, can help identify waste, abuse and fraud in health insurance claims - currently tailored for GCC region. The results of the first claims analysis by our machine learning solution were presented at a conference in Oman and stated in a UAE newspaper article.

The results of the first claims analysis conducted in the UAE show that RiSIC increases denial rate from 5% to 8.4%., stated Kiril Milev, our Managing Director of the Middle East division his interview at the UAE newspaper National. In addition, he presented the results also at the Middle East Healthcare Insurance Conference on 25 September 2018, in Oman, see presentation here.

The UAE specifically is a high-risk market for insurers because the healthcare market is growing at such a fast pace. The market is dominated by the private sector with a mandatory insurance requirement. In the conducted analysis, we detected absurd amounts of fraud, waste and abuse. Remarkable about our product RiSIC is that it is fed with historical data and tunes up for the business specifics, starting its first day on the job already understanding the local market nuances and unique claims patterns that the business deals with.

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