Fair, Isaac Partners with EDS to Detect Fraud and Abuse in Eastern States Medicare Claims

Fair, Isaac and Company, Inc. a provider of analytics and decision technology, announced that global technology services company EDS has selected the Fair, Isaac Payment Optimizer solution to provide fraud detection services for the Eastern Medicare Benefit Integrity Support Center (EA-BISC).

The EA-BISC was established by the Centers for Medicare and Medicaid Services (CMS) to identify and deter Medicare fraud and abuse in Eastern states including New York and New Jersey. As the prime contractor, EDS will apply the predictive analytic capabilities of Fair, Isaac’s Payment Optimizer solution to help detect fraudulent and abusive patterns earlier and more accurately in the EA-BISC’s claims review process.

Specifically, the solution will support the EA-BISC in achieving its mission to reduce the number of fraudulent or abusive claims submitted, develop quality fraud cases for referral to the Office of Inspector General and other law enforcement agencies, and develop and validate methodologies for the early detection and prevention of fraudulent schemes and abusive use of services.

“We chose Fair, Isaac to be a member of our team because their fraud detection technology is the industry-leading solution with a track record of accurately identifying suspicious claims,” said Al Edmonds, president, EDS U.S. Government Solutions. “Fair, Isaac’s Payment Optimizer solution has identified millions of dollars worth of fraudulent claims for EDS clients, and Fair, Isaac continually works to improve its detection capabilities, adapting its system as the dynamics of fraud develop and change over time.”

Fair, Isaac Payment Optimizer is designed to detect fraud in Medicaid and Medicare programs, as well as commercial health plans.