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Cape Town - Discovery Holdings [JSE:DSY] recovered R250m in fraudulent claims last year through advanced analytics and big data technologies.
The fraud recovery was enabled by a new accelerated analytics landscape built by Discovery Health, in partnership with BITanium, an IBM business partner.
The system enables the company to run three years’ worth of data through complex statistical models to deliver actionable insights in a matter of minutes.
It allows for more accurate predictors for chronic conditions, helping Discovery initiate better preventative programmes, identifies possible “phantom drug” prescriptions by mining data from pharmacies and health providers, and cuts development time for predictive models.
Critically, the accelerated analytics system has significantly improved fraudulent claims recovery, allowing Discovery to control the costs of its services and ensure better healthcare for its members.
Estiaan Steenberg, actuary at Discovery Health, said: “From an analytical point of view, fraud is often a small intersection between two or more very large data-sets.
"We now have the tools we need to identify even the tiniest anomalies and trace suspicious transactions back to their source.
"For example, Discovery can now compare drug prescriptions collected by pharmacies across the country with healthcare providers’ records. If a prescription seems to have been issued by a provider, but the person fulfilling it has not visited that provider recently, it is a strong indicator that the prescription may be fraudulent."
The fraud recovery was enabled by a new accelerated analytics landscape built by Discovery Health, in partnership with BITanium, an IBM business partner.
The system enables the company to run three years’ worth of data through complex statistical models to deliver actionable insights in a matter of minutes.
It allows for more accurate predictors for chronic conditions, helping Discovery initiate better preventative programmes, identifies possible “phantom drug” prescriptions by mining data from pharmacies and health providers, and cuts development time for predictive models.
Critically, the accelerated analytics system has significantly improved fraudulent claims recovery, allowing Discovery to control the costs of its services and ensure better healthcare for its members.
Estiaan Steenberg, actuary at Discovery Health, said: “From an analytical point of view, fraud is often a small intersection between two or more very large data-sets.
"We now have the tools we need to identify even the tiniest anomalies and trace suspicious transactions back to their source.
"For example, Discovery can now compare drug prescriptions collected by pharmacies across the country with healthcare providers’ records. If a prescription seems to have been issued by a provider, but the person fulfilling it has not visited that provider recently, it is a strong indicator that the prescription may be fraudulent."
