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Diagnosing A Solution for Fraud Within The Medical Industry

Building a healthcare fraud prevention system

A division of one of our long-term health insurance clients was tasked with building a healthcare fraud prevention system, allowing the federal government to move away from a “pay and chase” model of recovering public funds to a more proactive approach.

Sogeti implemented a proof-of-concept system using Apache Hadoop, a Java-based, open-source, distributed software platform for processing and storing data. The team played an integral role in building and scaling up a production system to store and retrieve data as needed for the fraud prevention system.

As a result of Sogeti's innovative approach:

  • The system identified or prevented loss due to fraud by more than $800 million.
  • The system assisted law enforcement and prosecution—increasing the amount recovered from defendants by a nearly 6%.
  • The ROI of the second year was calculated at 5:1 (delivering $5 of revenue for every $1 invested).