Big Data Helps Reduce Medicaid Fraud

by Stephanie Rabinowotz | Aug 31, 2015 | Health Care

The state of North Carolina has 2 million medicaid patients and pays out $12 billion in Medicaid each year. Due to these high numbers, in 2010 governor Beverly Purdue announced a program to analyze medicaid claims. To do this, IBM was asked to step in to aid with healthcare analytics tools.

Since using the IBM Healthcare analytics there has been a 90% reduction in medicaid fraud. This software allows healthcare providers to see the patterns in medicaid claims and identify faulty claims against true claims. The great part about the use of Big Data analytics is that the IBM software can take the data collected from medicaid claims and put it into a visual format that is easy to understand. This allows for doctors and nurses to identify the fraudulent claims rather that rely on data scientists.

The use of big data analytics in the healthcare system not only aids in picking out the patterns that discover fraud, but it is also showing the population that there are people watching them and that they will be caught.

Thanks to Big Data analytics the state of North Carolina has decreased the rate of medicaid fraud and continues to search for those who dare to commit it.