SAS partners NHA for fraud detection, prevention through data analytics

Tech firm SAS on Tuesday said it has partnered with the National Health Authority (NHA) to enable data analytics for the latter’s 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 will provide end-to-end framework to ensure claim processing with specific components for fraud detection, alert management and case handling for NHA, a statement said.

It said 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, it added.

This will contribute to the NHA’s overall objective of detecting and minimising healthcare fraud using advanced analytics, it added.

“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 aimed 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 disparate 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 anomalies and detect and prevent fraud and abuse from occurring across the board.


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