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High probability to dispute
%
3,5
3,5
Suspicious services
%
8,4
8,4
Category
Claims, €
# of services
% in claims
Total Claims
6 742 086
101 144
100%
Fraud detected
564 307
11 357
8,4%
Low probability
91 521
1 2016
1,4%
Medium probability
239 162
5 472
3,5%
High probability
233 623
4 669
3,5%
% of suspicious services
Clinic 1
Clinic 2
Clinic 3
Clinic 4
Clinic 5
Clinic 6
Clinic 7
Medical partner
We found 8% of suspicious services with a different probability rate. 3.5% are highly probable to dispute
Outcome 1
Service name classification, medical case aggregation, identification complex patterns of fraud.
Advanced health analytics for further management decisions
Advanced health analytics for further management decisions
Outcome 2
Medical partner
% of suspicious services
Laboratory services, General
Biochemical tests
Ultrasound examination
Gynecologist services
Otolaryngologist services
Dermatologist services
Radiology
Clinic 1
6,6%
1,6%
1,1%
1,0%
0,0%
0,0%
0,3%
Clinic 2
17,2%
7,6%
0,0%
0,5%
0,0%
0,0%
0,0%
Clinic 3
8,2%
0,8%
0,5%
0,0%
2,1%
3,3%
0,0%
Clinic 4
15,9%
4,0%
0,0%
0,0%
1,4%
0,0%
0,0%
Clinic 5
Clinic 6
Clinic 7
4,6%
5,9%
5,4%
2,1%
0,2%
0,0%
0,2%
0,0%
0,2%
1,5%
0,2%
1,5%
0,1%
0,4%
0,3%
2,4%
0,5%
0,0%
0,0%
0,0%
0,0%
2,0%
8,3%
0,6%
9,5%
1,2%
1,8%
1,1%