Computer programs help flag insurance fraud before payment - USATODAY.com

"Everyone is trying to see if they can catch the fraud before the check goes out the door," says Andrea Allmon, director of health care operations at Fair Isaac, a firm known for its credit card scoring model that also sells health fraud detection computer systems. That's because companies can save far more money by stopping claims before they are paid than trying to get fraudsters to pay back money. Insurer Aetna says its new computer software helped it stop $89 million in payments before they reached medical providers last year. That compares with the $15 million in fraud repayments it was able to collect after the fact. But many states require medical claims to be paid promptly, which means insurers must be able to review claims, spot problems and do investigations very quickly.