IBM and PRO BTP Use Analytics to Fight Healthcare Insurance Fraud and Abuse-- Deployed in the cloud the platform enables the fight against fraud and abuse in optical and dental care-- The solution will be deployed in other medical specialties and life and protection insurance

PR Newswire

ARMONK NY Oct. 16 2014

ARMONK NY Oct. 16 2014 /PRNewswire/ -- IBM (NYSE: IBM) today announced that it signed a seven-year agreement with PRO BTP one of the primary welfare institutions in France to fight healthcare insurance fraud.Built with IBMs Smarter counter fraud Software and Services the new SOLON cloud business solution uses advanced analytics to detect fraud patterns and suspicious activity qualify them in real time and decide how they should be treated.

The growth of electronic transactions has given rise to new opportunities for fraud and abuse. For example improper payments today represent between 5 and 7 percent of all reimbursements made today by PRO BTP.The new SOLON platform allows the insurance provider to identify issues at the moment of payment for optical and dental reimbursements. 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 said 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 IBMs 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.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 EUR14 million in potential losses. This detection was achieved through the use of IBMs predictive analytics solutions and the integration of numerous sources of data.

Silvano Sansoni Vice President Industries and Business Development IBM France added: We are delighted to bring our deep knowledge of data management and our expertise in counter-fraud and abuse solutions and services to PRO BTP. This is a joint development partnership and the outcome of huge IBM investments. It supports this new idea that fraud cannot and must not be considered as a cost of doing business.

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.

About PRO BTPA social protection group for the Construction and Public Sectors PRO BTP serves 3.5 million members and 208000 businesses. With A non-profit and joint management principles PRO BTP offers benefits and services to employees retirees craftsmen and construction companies in the area of pensions health care savings insurance social action and holidays.

The Group has a network of 114 local advice agencies located throughout France to welcome inform and advise its members.

In 2013 PRO BTP was the countrys leading professional social protection group with activities amounting to 6.5 billion euros of which 3.7 billion resulted from pension contributions and 2.7 billion in contributions relating to personal insurance (life and individual protection insurance supplemental health insurance and personal savings).

About IBM For more information about IBMs Smarter counter fraud initiative visit www.ibm.com/smartercounterfraud.

Follow the conversation on Twitter at #counterfraud

Contact:Sandrine DuruptIBM Media Relations+33-1-5875-1795 This email address is being protected from spambots. You need JavaScript enabled to view it.

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SOURCEIBM

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Last updated on: 16/10/2014