SYSTEMS AND METHODS FOR DETECTING FRAUDULENT HEALTHCARE CLAIM ACTIVITY

摘要

A method and system are provided for detecting fraudulent healthcare claim activity. An example system includes an analyzer to receive eligibility data related to an interaction between a service provider and a service recipient, and to generate one or more risk scores based on the eligibility data for a subsequent claim submitted based on the eligibility data, the eligibility data being accessed from at least one of a data stream and a storage component; a translator to interpret the one or more risk scores from the analyzer and to generate a user format representative of the one or more risk scores for the subsequent claim; and an interface component to cause a display of the user format.