Case study: Fair Isaac

Taking a scalpel to health-care fraud ...

• Nabbed: a physician that overbilled Medicare for $3 million.
• Nabbed: specialists who charged for procedures that weren't performed.
• Nabbed: a psychiatrist who reported 112 patients in a single day for 75-minute procedures, or 140 billable hours.

Intelligent analytics software developer Fair Isaac (NYSE: FIC) released a new suite of health-care intelligent analytics to help health-care payers and providers reduce health-care fraud, which caused estimated annual losses ranging from $54 billion to $90 billion, more than 200 times higher than credit-card fraud.

In less than one year, Cook & Schmid successfully placed antifraud white papers in six leading industry trade journals and wrote a research paper for the health-care forecast report from Montgomery Research. The agency introduced Fair Isaac to staff of the 21st Century Health Care Caucus and the Leapfrog Group in Washington, part of the Business Roundtable and dedicated to taking an aggressive stand against rising health-care costs. News releases on the company’s new software received extensive coverage, and case histories demonstrated significant results in fraud detection.