GEHA Selects FICO Analytic Solution to Intensify Fight Against Insurance Fraud, Waste and Abuse

MINNEAPOLIS, Feb. 9, 2012 /PRNewswire/ -- FICO (NYSE: FICO), the leading provider of analytics and decision management technology, today announced that the Government Employees Health Association (GEHA) has upgraded to FICO® Insurance Fraud Manager and will be adding FICO® Blaze Advisor® business rules management systems to help it more broadly and effectively detect and prevent insurance fraud, waste and abuse (FWA).

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GEHA is the second-largest national health plan and the second-largest national dental plan for federal employees, retirees and family members, serving more than one million covered lives worldwide. GEHA has been a long time user of FICO analytics to analyze medical claims and fight fraud prior to payment, achieving significant cost savings and an exponential increase in case targeting effectiveness. Now, with the upgrade to FICO® Insurance Fraud Manager, GEHA can not only monitor medical claims but also can manage pharmacy and dental claims with fraud detection and prevention models, discovering new fraud schemes in additional areas. GEHA also will be using FICO® Blaze Advisor® business rules to proactively evaluate claims and stop known fraud earlier in the process, driving greater efficiency and results.

"Like other carriers, we want to increase the number of claims processed electronically and without adjuster intervention," says Bob Greene, manager of data analysis at GEHA.  "At the same time, we wanted the most accurate FWA detection and the ability to prioritize our investigatory efforts. We've realized great return from using FICO analytics in the past, and are eager to ramp up with Insurance Fraud Manager and Blaze Advisor because they will help us achieve our mandate of providing the best possible care and protection to our clients at a fair price and with excellent service."

FICO® Insurance Fraud Manager detects fraud, abuse and errors in health care claims and identifies suspicious providers as soon as aberrant behavior patterns emerge. Providers can accelerate claims processing while saving money by avoiding improper payments, increasing loss recovery and correcting systemic vulnerabilities. The system also provides low total cost of ownership yet high return on investment with simple system administration and intelligent tools that streamline review and investigation of suspicious claims.

"Many organizations have adopted FICO's analytics-based solutions to address the enormously costly problem of health care fraud, waste and abuse," said Russ Schreiber, vice president and insurance practice leader at FICO. "With the powerhouse combination of FICO's analytics to detect new and emerging fraud and FICO's business rules management to stop known fraud earlier, our insurance clients can achieve tremendous efficiency and return on investment."

About FICO

FICO (NYSE:FICO) delivers superior predictive analytics solutions that drive smarter decisions. The company's groundbreaking use of mathematics to predict consumer behavior has transformed entire industries and revolutionized the way risk is managed and products are marketed. FICO's innovative solutions include the FICO® Score — the standard measure of consumer credit risk in the United States — along with industry-leading solutions for managing credit accounts, identifying and minimizing the impact of fraud, and customizing consumer offers with pinpoint accuracy. Most of the world's top banks, as well as leading insurers, retailers, pharmaceutical companies and government agencies, rely on FICO solutions to accelerate growth, control risk, boost profits and meet regulatory and competitive demands. FICO also helps millions of individuals manage their personal credit health through www.myFICO.com. Learn more at www.fico.com. FICO: Make every decision count^™.

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SOURCE FICO