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Products & Services

Tax and Healthcare Fraud

Tax and Healthcare Fraud
The NetReveal® Tax, Benefit and US Healthcare Fraud solutions enable government agencies to uncover waste and misuse, stopping fraud and increasing revenue.
Governments and government agencies are the target of multi-billion dollar fraud attacks, via both tax avoidance and waste and fraudulent misuse of healthcare and benefit schemes. These agencies need to quickly and accurately spot suspicious networks and behaviours to prevent fraud, and ensure government resources and revenues are allocated and collected appropriately.
 

NetReveal Tax and Benefits Fraud

The NetReveal Tax and Benefits Fraud solution enables government agencies to make better-informed decisions on each and every return, claim, or case. By creating a single view of all individuals, companies, addresses and other entities, the solution identifies cases with a high risk of error, non-compliance, debt, fraud or serious criminal activity. Our clients have used this technology to achieve a step-change in effectiveness for all aspects of their fraud and compliance strategy: education, prevention, detection, investigations and audit.
 

NetReveal Healthcare Fraud 

The NetReveal Healthcare Fraud solution provides greater accuracy in claims handling, stopping the cycle of ‘pay and chase’ by blocking the payment of suspicious claims before the payment. By analysing every claim in the context of the history of the beneficiary and providers, as well as taking into account any relationship to other parties, not only are current and future claims stopped, but suspicious behaviour is automatically identified, allowing easy post-pay recovery of previous instances.
 
 

Key benefits

Our Tax, Benefit and Healthcare Fraud solutions enable government agencies to:
  • Spot fraud activity early – Gain a holistic view of risk, evaluating every individual, provider, or other entity, uncovering patterns of relationships and quickly identifying previously undetected methods of fraud 
  • Reduce risk and red tape – Balance fraud detection and beneficiary experience, allowing low risk providers and claims are able to be paid quickly, while focusing on the highest risks
  • Increase accuracy at scale – Uncover fraud quickly, risk assessing every claim in real-time through a combination of sophisticated statistical pattern-matching, machine learning and social network analysis 
  • Speed investigation and resolution – Simplify incident response and reduce time spent on investigations from weeks to days or hours, by empowering investigators with intelligent risk prioritisation and intuitive research tools
 

Key features

  • Comprehensive data integration 
  • Advanced, accurate risk detection
  • Holistic view of activity
  • Intelligent risk scoring
  • Real-time fraud detection
  • Consistent investigation process