Fraud Management Solution

Insurance fraud detection in healthcare involves analyzing claims for misleading or false information to get payers to reimburse ineligible medical procedures. Numerous insurance payers often use fraud management solutions to streamline and automate parts or entire investigative processes to filter out and flag suspicious claims. Investigating each claim manually is not only slow and tedious but not efficient, as an average payer is likely to deal with hundreds or even thousands of claims each day. In light of this, a reliable fraud management solution saves time and revenue.     

Let’s build your project

Explore Fraud Waste Abuse System

Our fully-integrated and browser-based fraud software offer comprehensive functionality for predictive fraud detection in healthcare. At OSP, we create predictive data analysis that encompasses advanced analytics techniques, like statistics, text mining, data mining, and decision support engines. Our healthcare fraud software analyzes the complex and interrelated relationships among thousands of data sets to provide a potential fraud occurrence. We create medical fraud management systems that employ memory-based reasoning to identify similar cases from experience. It applies the collected information from these cases for in-depth classification and prediction. The memory-based reasoning applies to arbitrary data types, even non-relational data.

OSP’ bespoke fraud management systems can provide user provisioning protocols – including role assignment, user management, and Single Sign-On (SSO) functions. The effective fraud detection software solution is made possible with user activity monitoring, access request management, and account management of multiple digital identities. Furthermore, we deploy automated fraud alerts to monitor patient data and receive emails when new information arises. Our tailored fraud management software allows access to proprietary detection technology, which identifies providers displaying anomalous patient billing trends and patterns through data mining technologies. OSP’s fraud management software is tailor-made to address the vulnerabilities within a particular healthcare organization, in tandem with specific users, providers, and patients in question.

Remain compliant with state policies for healthcare payments to reduce investigation costs and avoid overpayments. Through electronic healthcare fraud detection technologies, we use automated systems that are free of errors, commonly made by human entries. This is because the technology used is consistent in its data entry features and in its analysis of the very same data to ensure holistic compliance. This feature is a must-have and eliminates the requirement for manual intervention of data reentries. The healthcare fraud detection system is geared to generate the data based on initial entries automatically. Thus, the data is organically created and generated and programmed efficiently. The software can be created with the provision of regular updates to keep up with evolving compliance requirements.

OSP’ healthcare fraud detection solutions can be made to find the concealed relationship among multiple payment data parameters, which may not be otherwise apparent. Further, our systems minimize the complexity of visual variance analysis by reducing the multi-dimensional data sets to 2 -3 dimensions. We build healthcare fraud detection solutions to create satisfaction among all healthcare industry entities through a diminished financial burden. Through our customized approach, we adhere to the organization’s specific requirements and build software that is easy to use, rich in features, and user-friendly in its approach through multiple functionality levels. Our software can be well integrated into the EHR system of the healthcare agency or practice.

OSP’s fraud detection software solutions can streamline the process through the entire lifecycle of claims submission. Whether it is a convenience of electronic data entry or validation through the use of technology or even the flexibility of errors being flagged before submission – the benefits are endless of a carefully crafted system that is evident in increasing revenue. Through intelligent technologies within the fraud detection software solutions, we offer the Optical Character Recognition (OCR), which has a high potential in diminishing the possibility of serious errors in coding and claims filing. This is done through the efficient scanning of documents and electronic programming and isolation.

Our solutions are created with the capacity to highlight claims that are likely to be rejected or refused. This will enable faster problem-solving and efficiency, thereby increased. Based on past inputs, our fraud detection software can predict claims that are potentially those which could be denied. Prioritization becomes much easier through this feature, with attention demanded towards areas of immediate attention, such as pending matters. Accessibility is further increased through electronic documentation and records and real-time access to current and past records, along with areas that need to be checked. It also reduces the need for manual processing. Finally, professional claims can be adjudicated in real-time through interactive, transactional experiences.


This is the biggest advantage of using a fraud management system for healthcare payers. Experts estimate that insurance fraud costs billions of dollars annually in losses for the healthcare industry. In light of this, OSP can leverage its decade-long experience in healthcare technology to build custom solutions for payers and improve the efficiency and productivity of claims analytics. This prevents fraudulent claims from being approved and saves precious revenue.  

An average insurance payer may process hundreds of claims daily from numerous payers. In the absence of fraud management systems, verifying each claim is inefficient and slow, and error-prone. As a result, it would take longer to assess and approve or disapprove claims that deviate from normalcy. But using software for healthcare fraud detection accelerates the entire process, getting treatments approved and coverage reimbursed faster.

OSP can build a fraud management solution customized to payer needs that can detect any patterns of deviation from established baselines of regular claims. This not only speeds up the process of identifying suspicious claims but also highlights the methods used by fraudsters to try and pass off inauthentic claims as genuine ones. This type of awareness improves fraud detection's efficiency and productivity and enables payers to respond better to such claims.

Let’s build your project

Boost Your Revenue

OSP's RCM application is a one-stop solution for all your billing and revenue cycle needs. Streamline your workflows, identify scopes of cash flow and reduce denials.


Fraud Management Software Development Services


Development of Insurance Fraud Detection Software

  • Automated claims adjudication features highlight discrepancies in claims
  • Rules engine to flag down suspicious claims for manual inspection
  • Analytics to process claims data for identifying useful patterns
  • Interactive interface to maximize user convenience
  • Integrated features to streamline activities in fraud management

Design of a Customized Fraud Management Solution 

  • Comprehensive assessment of the operations and services of the payer company
  • Development of a fraud investigation software to match the requirements
  • A dashboard for an aggregated view of operational metrics
  • Accelerated response to the detection of a fraudulent claim
  • Rigorous testing to ensure that the platform is HIPAA compliant

Development of Healthcare Fraud Detection Solutions

  • Interactive dashboard to display claim information
  • Functions for streamlining workflows in fraud management
  • Rules-based engine for claims adjudication with adjustable parameters
  • Rapid assessment of suspicious claims
  • Data analytics of fraudulent claims to derive actionable insights

Our Core Services

Solutions We Offer

What Our Client Said

Industry Industry Industry Industry Industry Industry Industry Industry Industry Industry

Case Studies

Let's Begin

Latest Talks


Everything You Should Know About Healthcare Revenue Cycle Analytics in 2022

Read More Hear

Introducing Provider Revenue Cycle Management – Must-Have Features for Maximum ROI

Read More Hear

The 7 Must-Haves of Hospital Revenue Cycle Management Systems

Read More Hear

Medical Insurance Billing Software: The Right Choice Among Custom Vs. Pre-built?

Read More Hear

7 Myths You Must Avoid While Developing Health Insurance Software

Read More Hear

Everything You Should Know About Healthcare Claims Adjudication Software

Read More Hear

Frequently Asked Questions

Fraud Waste Abuse (FWA) systems are used by healthcare organizations to detect and prevent fictitious bills, fraudulent activities, unnecessary expenses, and misuse of resources, ensuring financial integrity and compliance. It is essential for healthcare organizations because it uses predictive data analysis to predict fraud detection in healthcare. It can identify suspicious patterns and analyze complex and interrelated relationships among various data sets to provide a potential fraud occurrence. FWA systems flag irregularities, help healthcare facilities mitigate financial losses and maintain patients’ trust.

Healthcare fraud detection software solutions offer numerous benefits to organizations. It helps prevent fraud, unlawful activities, and intentional deceiving for financial gain by identifying suspicious patterns and enabling timely intervention to prevent losses and protect patients from unnecessary procedures. Such solutions even adhere to healthcare regulations, preventing the organization’s reputation and avoiding legal consequences. Overall, it reduces costs, enhances operational efficiency, maintains stakeholder trust, and encourages ethical standards.

Healthcare fraud detection software solutions can be integrated with existing healthcare IT systems. These solutions are designed to enhance the existing healthcare infrastructure. Its compatibility with various protocols and data formats allows seamless integration with EHRs, claims processing software, billing systems, and other IT systems, facilitating a holistic approach to fraud detection and prevention. It further minimizes disruption in the existing workflows.

A Fraud Waste Abuse (FWA) System aids healthcare organizations in combating fraud by employing advanced algorithms and data analytics to detect anomalies and discrepancies in claims patterns indicative of fraudulent activities, billing, and patient records. Key components of effective FWA systems include data analysis, user provisioning protocols, employee training, etc. The system ensures continuous monitoring to identify irregularities, like unnecessary procedures, duplicate billing, or variations from established norms, allowing timely intervention and mitigating financial losses.

A Fraud Waste Abuse (FWA) System can be customized to meet specific organizational needs. Healthcare organizations can tailor the system’s parameters, algorithms, and rules to align with their unique fraud detection requirements, compliance standards, and operational processes. For an aggregated view of operational metrics, you can customize it with a detailed dashboard feature. The system prevents fraudulent claims from being approved and limits the improper use of resources, saving precious revenue.

Fraud, Waste, and Abuse (FWA) Management in healthcare plays a vital role in cost containment by identifying and preventing inappropriate or unnecessary expenditures. It also helps in cost recovery and eliminates waste (refers to careless expenditure of resources) and abuse (refers to the improper use of resources). By implementing robust FWA detection systems, healthcare organizations can reduce financial losses caused by fraudulent activities, like billing for services not rendered, upcoding, unbundling, overcharging, etc.

Technology, such as fraud detection software, plays a vital role in Fraud Waste and Abuse (FWA) Management. These advanced software systems leverage data analytics, AI, and MI algorithms to analyze vast healthcare claims and transactions in real-time. It detects fraudulent activities, identifies cost outliers, automates the rule-matching process, and red flags wasteful, fraudulent, and abusive insurance claims. Additionally, it helps in enabling proactive interventions.

Healthcare organizations can effectively manage Fraud, Waste, and Abuse (FWA) by implementing comprehensive strategies. These strategies may include establishing clear procedures and policies, conducting regular staff training, and adhering to regulatory compliance. It can prevent, detect, and resolve conduct that does not conform to federal, state, and private payers’ health care program requirements. Also, organizations can utilize advanced technology, like Fraud Detection Software, that allows real-time monitoring and analysis of claims declared.

Providers can detect healthcare fraud and abuse by implementing appropriate policies, compliance programs, and understanding key healthcare fraud laws. They should follow vigilant practices involving thoroughly verifying patient information, scrutinizing billing and coding accuracy, and cross-referencing claims against medical records. They can also utilize advanced fraud detection software to identify irregular patterns, associations, and anomalies within their billing data. Further, they can collaborate with payers and law enforcement agencies to enhance fraud detection efforts.

Healthcare fraud involves intended deception or misrepresentation for personal gain. It typically involves deliberate actions to unlawfully get benefits or payments from healthcare programs. Healthcare abuse, on the other hand, refers to practices that are inconsistent with accepted medical standards. It refers to the actions that are improper and inappropriate, resulting in unnecessary costs to healthcare programs. Both fraud and abuse undermine the integrity of healthcare systems, but fraud involves intentional deception, whereas abuse often involves overuse or misuse without fraudulent intent.

OSP aids healthcare organizations by providing customized solutions that implement strategies to identify, deter, and mitigate fraud, waste, and abuse within their operations. We develop robust compliance frameworks, promote best practices, and leverage advanced technologies, like predictive analytics, to prevent financial losses due to improper activities. Our custom solutions reduce healthcare costs, ensure regulatory compliance, and protect patients and providers from harm.

Yes, OSP provides customizable healthcare fraud management solutions tailored to the specific needs of healthcare organizations. We collaborate closely with our clients to understand their unique operational environments, risk factors, and compliance requirements. Later, we provide custom solutions to detect and prevent healthcare fraud, waste, and abuse while adhering to compliance and the organization’s financial goals. Leveraging advanced analytics and industry expertise, we help organizations safeguard their financial resources and enhance their fraud detection capabilities.

Healthcare organizations gain access to specialized expertise and advanced technology solutions when partnering with OSP for Fraud Waste Abuse (FWA) Management Software development. We leverage our decade-long experience in healthcare technology to build custom software solutions and help organizations improve their Fraud Waste Abuse Management. Our customized solution can speed up the process of identifying suspicious claims and even highlight the methods used by fraudsters to try and pass off inauthentic claims as genuine ones. Organizations can strengthen their defenses against financial losses by partnering with us and upholding regulatory compliance standards.

OSP can assist healthcare organizations with custom healthcare fraud detection software solutions. Our tailored software uses advanced technological tools to help organizations identify suspicious patterns and anomalies in medical coding, billing, and claims data. It leverages data analytics and predictive modeling to detect potential instances of fraud in real-time. Further, we can provide various customized features like predictive data analysis, user provisioning protocols, compliance management, link and component analysis, highlighted discrepancies, etc.

OSP offers various custom features and functionalities that can help in claims fraud detection. These features include optical character recognition, user provisioning protocols, predictive data analysis, compliance management, highlighted discrepancies, link and component analysis, etc. Our tailored systems minimize the complexity of visual variance analysis by reducing the multi-dimensional data sets to 2D and 3D. We can provide an interactive dashboard to display claim information. Further, we also conduct rapid assessments of suspicious claims and more.

OSP can support healthcare organizations in managing fraud, waste, and abuse by offering customized, comprehensive solutions with real-time monitoring and advanced analytics features. Our custom software can seamlessly integrate with the EHR system of the healthcare agency. Our tailored systems analyze vast amounts of data to detect irregularities in coding, billing, and claims processing, flagging potential instances of fraud or waste. We even offer training programs to educate staff on FWA detection and prevention strategies.

OSP offers training and support services for healthcare organizations using Fraud Waste Abuse Management Software. Our services encompass end-user training to ensure staff proficiency in utilizing the software effectively for fraud detection and deter. Training covers topics such as detecting, correcting, and preventing FWA. Additionally, we provide troubleshooting assistance, ongoing technical support, and regular updates for our clients to enhance software performance and tackle emerging threats.

Schedule A Call