Highmark Makes Healthcare-Fraud Prevention Top Priority With SAS

Overview

Health insurance fraud exacts a cruel toll on society, undercutting the quality of care and straining patients' wallets. The U.S. Government Accountability Office estimates that of the $1.7 trillion Americans spend on healthcare each year, between 3 and 10 percent is fraud related. Fortunately, companies like Highmark - the Pennsylvania-based Blue Cross Blue Shield affiliate that covers more than 25 million Americans - are hot on the trail of would-be fraudsters, who include the insured, providers, pharmacies and third-party billers. Using SAS Enterprise Miner, informatics specialists at Highmark build sophisticated models based on huge stores of claims, customer and provider data.