McKesson Introduces Health Insurance Fraud & Abuse Detection and Management Solution

With an estimated annual cost of $85 billion, fraud and abuse in the U.S. healthcare industry surpasses credit card fraud and identity theft. Now, the same technology that uncovers potential credit card fraud, is joined with expert clinical alert content and applied to the healthcare industry, to identify potential cases, before they are paid.

InvestiClaim automates the detection of fraud and abuse. It alerts users to aberrances and trends in claims data, highlighting the most probable cases, significantly reducing “false positive” leads, and saving resources for critical investigations. InvestiClaim incorporates analysis and case management tools, enabling health plans to streamline and automate the administrative tasks associated with conducting and managing investigations. The solution is customizable to meet the specific needs of each organization.

“With over 30 years of claims auditing and healthcare payor consulting expertise, we are now leveraging our clinical knowledge for assessing claims submissions,” said Carolyn Wukitch, senior vice president of McKesson Health Solutions products division. “Together with Fair Isaac, we have created a detection and management methodology that is best suited to meet payors’ business needs and unique, time-sensitive operational requirements.”

“Fair Isaac’s background is strongly rooted in working with the leading financial organizations in the country, and we are probably best known for FICO® scores which have become the standard measure of credit risk. By layering McKesson’s strong clinical knowledge with Fair Isaac’s advanced statistical analytics, healthcare payors now have an optimal opportunity to find the most likely instances of fraudulent or abusive claims submissions,” said Mike Gordon, vice president of insurance Fair Isaac. “We are excited about this partnership and this new ground-breaking solution.”

About McKesson Corporation

McKesson Corporation, currently ranked 18th on the FORTUNE 500, is a healthcare services and healthcare information technology company dedicated to helping its customers deliver high-quality healthcare by reducing costs, streamlining processes, and improving the quality and safety of patient care. McKesson is the longest-operating company in healthcare today, marking its 175^th anniversary this year. Over the course of its history, McKesson has grown by providing pharmaceutical and medical-surgical supply management across the spectrum of care; healthcare information technology for hospitals, physicians, homecare and payors; hospital and retail pharmacy automation; and services for manufacturers and payors designed to improve outcomes for patients. For more information, visit http://www.mckesson.com.

About Fair Isaac

Fair Isaac Corporation (NYSE:FIC) transforms business by making every decision count. Fair Isaac's Decision Management solutions combine trusted advice, world-class analytics and innovative applications to give organizations the power to automate, improve and connect decisions across their business. Clients in 80 countries work with Fair Isaac to increase customer loyalty and profitability, cut fraud losses, manage credit risk, meet regulatory and competitive demands, and rapidly build market share. Fair Isaac also helps millions of individuals manage their credit health through the www.myFICO.com website.