CNA Saves $7.5M Through Analytics-Based Fraud Detection
INN Breaking News, May 6, 2014
The recent fraud case against California hospital owner Michael Drobot, who according to the Federal Bureau of Investigation, allegedly ran a health care fraud scheme that involved tens of millions of dollars in illegal kickbacks in exchange for referrals of thousands of patients who received spinal surgeries, is providing CNA with new opportunities to analyze for fraud, Wolfe said. The hospital referrals led to more than $500 million in bills being fraudulently submitted during last five years of the scheme, much of which was paid by the California worker’s compensation system. Wolfe said CNA was affected by only $5 million of that, and that the data is analyzed to figure out the strengths and weaknesses of the models so they can be improved.
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