As part of the agreement, AfroCentric’s healthcare IT services subsidiary, Helios IT Solutions (Helios ITS), and FICO offer a fraud management and payment integrity platform to all medical schemes in South Africa.
FICO Insurance Fraud Manager uses adaptive predictive analytic models that are integrated within purpose-built software, allowing medical schemes (payers) to identify and address existing and emerging losses from fraud, waste and abuse. Medical schemes can use this solution, deployed through Helios ITS’ technological offering, to detect, review and investigate suspicious claims, members and providers.
According to Paul Midlane, AfroCentric’s general manager of Legal Governance and Risk Compliance, healthcare fraud is on the rise, accounting for between 10 and 20 percent of gross healthcare claim payments globally.FICO, formerly known as Fair Isaac, is an analytics software company, helping businesses in more than 90 countries make better decisions that drive higher levels of growth, profitability and customer satisfaction.
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