Fraud, Waste & Abuse

Exela uses a proprietary combination of rule engines and artificial intelligence schemes to mine and detect abuse patterns in real-time. Exela extracts clues not just from the document dataset, but also from public records, proprietary databases, and web content. This pairing of external data with the actual document being analyzed results in a more comprehensive detection engine and superior performance.

Key Features

Real-time Discovery

  • Integrate with pre-and post-payment data sources and analysis tools
  • Mine data to detect patterns and relationships in real-time

Alerts & Reports

  • Deploy automated/semi-automated alerts and reports
  • Select rule templates, apply weights, and adjust thresholds

Case Tracking

  • Track cases with dynamic, intelligent role-based dashboards and reporting tools
  • Apps for in-the-field reporting / case building 

Recovery

  • First and third party collection services
  • Manage referrals, demand letters, and appeals

Servicing

  • Flag, edit, and resolve fraudulent claims
  • Engage fraudulent agents through multiple communication systems
  • Expense reporting and accounts payable analysis for internal audit
 

Iterative Improvements

  • Suspect claims checked for accuracy and used to refine training sets
  • Perform root cause analysis to avoid future impact

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