The healthcare industry faces an escalating fraud problem, with some estimates placing losses as high as 10% of total healthcare spending. That’s over $300 billion wasted each year. Traditional, internal-only data systems leave blind spots—especially when it comes to verifying identities and payment information.
External data changes that.
By supplementing internal data with third-party sources like employment history, socioeconomic indicators, and identity verification services, healthcare providers and insurers can take a more proactive, holistic approach to fraud prevention.
Why External Data Strengthens Healthcare Security
✅ Authenticate patient identities with external verification tools
✅ Detect fraudulent transactions by cross-referencing third-party payment data
✅ Reduce false positives and speed up claim reviews
✅ Enrich patient profiles with socioeconomic and lifestyle context for more informed decisions
How It Works
🔹 Feed identity and payment verification data into ML algorithms to detect discrepancies
🔹 Use neural networks to uncover complex fraud patterns in real-time
🔹 Apply anomaly detection to flag outliers before they become costly issues
Real-World Impact: Scaling Fraud Detection with AI
Anthem worked with Google Cloud to generate 1.5–2 petabytes of synthetic data for AI-powered fraud detection. The result: scalable, efficient claims monitoring and personalized services—with enhanced protection against fraud and abuse.
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📩 Want to reduce fraud losses and boost your data-driven security strategy? Connect with Blue Street Data to unlock the external insights your healthcare systems are missing.
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