SAS Joins Hands With NHA For Fraud Detection And Prevention

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  • SAS would provide end-to-end framework to ensure claim processing with certain components of fraud detection, alert management, etc
  • SAS also partnered with state govts to epidemiological models to predict timing and magnitude of Covid-19 infection
  • Advanced data analytics will be deployed to all the claims being processed and administered to detect and prevent fraud and abuse occurring across the board. 

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According to a report, Tech firm SAS has partnered with the National Health Authority (NHA). The partnership is primarily to enable data analytics for the National Anti Fraud Unit (NAFU) to help monitor fraud and abuse in the implementation structure of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana ( AB PM-Jay ) scheme. 

SAS would provide end-to-end framework to ensure claim processing with specific components for fraud detection, alert management and case handling for NHA.

Fraud and abuse data model 

It has also been reported that through the Fraud Analytics Control and Tracking System (FACTS) of NHA, SAS will also support the prevention and detection of fraud. It will be done through a healthcare-specific fraud and abuse data model that consolidates data from internal and external sources including claims systems, third parties as well as unstructured text.

“Providing healthcare access to the poor and vulnerable families across India is a complex process. But, data backed with analytics can ascertain a holistic view.

NHA’s FACTS project is an aimed project at detecting and minimising healthcare fraud using advanced analytics,” SAS India Vice-President and Managing Director Noshin Kagalwalla said.

He added that with SAS software, the company has provided a framework of support to not just detect and prevent fraudulent claims but also provide a broader view of patients being served under the PM-JAY scheme.

“After a six month-long proof of concept exercise where five top global analytics firms participated, we are pleased to select and have SAS support us in analysing one of the largest data sets pertaining to health care administration through a central platform,” NHA Chief Executive Officer Indu Bhushan said.

Advanced data analytics will be deployed to all the claims being processed and administered to identify abnormalities and detect and prevent fraud and abuse from occurring across the board.

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