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White Paper

Before Claims Fraud, What About Eligibility Fraud?

About this paper

When thinking about the fraud in health care, people tend to think about the integrity of the way claims are presented – and they tend to think about it as a provider issue. Jay King and Julie Malida of SAS want to shift the conversation to the multimillion-dollar question: Is your plan actually covering the people you think you're covering? This white paper summarizes a webinar in which King and Malida share insights about the scope of eligibility fraud, the data sources you can use to address it, and five real-world case studies of eligibility fraud detection in action.

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