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Identify and Prevent Fraud

Fraud detection is usually manual and labor-intensive. At scale, it can be a tricky problem to tackle. Learn how RapidMiner helped this organization apply AI to identify $20M of fraud.

The Challenge

  • Healthcare fraud can be challenging to detect
    • Even for intelligent medical providers & patients
    • Fraudsters well versed in remaining undetected
  • Using a manual process to catch fraud wasn’t working
    • Random samples selected for inspection
    • Less than 5% of all transactions were inspected
    • Time-consuming & limited resources

The Solution

  • Focused on specific behavioral patterns
  • Easily prototyped & tested effectiveness of ML
  • Supervised learning deployed:
    • Scan and flag high-risk fraud cases
    • In high volume, in real-time
  • Integrated a variety of new sources:
    • Detection of fraud networks 
    • Contextual clues that surround fraudulent acts

The Impact

  • $20M Fraud identified
  • New end-to-end detection & prevention process
  • Able to identify and prioritize high-risk cases
    • Reduced time wasted with random inspections
    • Detect new fraud patterns
  • New categories of fraud discovered

Get started with your fraud detection project today!

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