Excellus BlueCross BlueShield and IBM Corp. are working together to fight health care insurance fraud.
IBM’s Risk Identification Analysis Service will be used by Excellus to review pharmacy-related claims to uncover complex schemes, the companies said. Such schemes include collusion, inappropriate billing practices, prescription forging, prescription pad theft and members who engage in “doctor shopping.”
“Someone who knowingly commits insurance fraud is no different than any other person who steals,” said Flora Allen, corporate director of Excellus’ special investigations unit. “Fraud affects everyone’s bottom line, so we aggressively and proactively pursue recoveries and convictions because we are protecting our members’ premiums.”
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