Healthcare Fraud is very difficult to detect because a variety of nuanced methods are employed, investigative evidence is often buried in text documents, and there can be collusion among network providers. Excessive or redundant Medical services, medical coding errors, improper billing, as well as outright fraud, continue to be significant challenges for health insurers.

The Department of Labor Office of Inspector General wanted to develop an effective fraud detection solution to prioritize high-risk workers’ compensation claims for investigation.