SAS helps Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to leverage Data Analytics for Fraud Detection & Prevention – Times of India

Noshin Kagalwalla, VP & MD , SAS India (L) & Dr. Indu Bhushan, CEO, National Health Authority (R) shake arms as the 2 organizations, companion to leverage Analytics for Fraud Detection & Prevention in World’s largest healthcare scheme

Mumbai, July 28 2020: SAS has introduced it has partnered with National Health Authority (NHA), the apex authorities physique implementing India’s flagship public medical health insurance/assurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). SAS will allow information analytics for NHA’s National Anti-Fraud Unit (NAFU) to assist monitor fraud and abuse arising wherever within the implementation construction of the scheme.
Through the Fraud Analytics Control and Tracking System (FACTS) of NHA, SAS can even assist the prevention and detection of fraud via a health-care particular fraud and abuse information mannequin that consolidates information from inside and exterior sources together with claims methods, third events in addition to unstructured textual content. Thus, contributing to the NHA’s total goal of detecting and minimizing well being care fraud utilizing superior analytics.
Noshin Kagalwalla, VP & Managing Director – SAS India mentioned, “Providing health care access to poor and vulnerable families across India is complex process. But data backed with analytics, can ascertain a holistic view. NHA’s FACTS project is aimed at detecting and minimizing health care fraud using advanced analytics. With SAS software, we have provided a framework of support to not just detect & prevent fraudulent claims but also provide a broader view of patients being served under the PM-JAY scheme”
SAS will present end-to-end framework for making certain declare processing with particular parts for fraud detection, alert administration and case dealing with for NHA. Dr. Indu Bhushan, Chief Executive Officer, National Health Authority mentioned, “After a six month-long proof of concept exercise where five top global analytics firms participated, we are pleased to select and have SAS support us in analyzing one of the largest disparate data sets pertaining to health care administration through a central platform. We will employ advanced data analytics to all the claims we are processing as well as administering to identify anomalies and detect and prevent fraud and abuse from occurring across the board. We are confident that with this, Ayushman Bharat PM-JAY will further strengthen its service delivery to more than 50 crore poorest citizens and empower them with quality secondary and tertiary healthcare.”
SAS’ fraud analytics engine enabled for NHA’s FACTS makes use of a number of methods comparable to automated enterprise guidelines, outlier evaluation, predictive modeling, textual content mining, database searches, exception reporting in addition to community hyperlink evaluation to uncover the probability of fraud for a medical health insurance scheme that advantages over 10.74 crore households residing in poverty. Furthermore, the analytics engine is enabled to make use of superior analytics with embedded synthetic intelligence (AI) and machine studying algorithms to forestall and detect fraud throughout India for the bold scheme.
Ayushman Bharat PM-JAY is the world’s largest government-supported well being assurance scheme that gives a well being cowl of Rs. 5 lakhs per household per 12 months to cowl secondary and tertiary care hospitalization to over 10.74 crore poor and susceptible households throughout India. So far, almost 95 lakh remedies value greater than Rs. 12,882 crore have been offered throughout 19,000 hospitals in 32 States and Union Territories.
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National Health Authority (NHA) is the apex physique of the Government of India accountable for the design, rollout and implementation of India’s flagship public medical health insurance/assurance scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana launched on 23rd September 2018. NHA is an autonomous physique functioning as an connected workplace of the Union Ministry of Health and Family Welfare.
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