Health Care Payment Integrity Through Advanced Analytics

Fraud, waste, and error continue to drain billions from health care systems, with as much as 25–30% of payments lost due to improper claims. This research brief, featuring insights from Ben Wright of SAS, explores how advanced analytics can radically improve health care payment integrity by predicting and preventing losses before they occur.

With today’s shift to bundled payments and changing patient demographics, the health care payment landscape is more complex than ever. Wright outlines how successful payment integrity requires a holistic, end-to-end approach—one that spans from policy definition to claims processing. Unlike traditional fraud detection, which focuses on a small portion of recoverable fraud, analytics-powered PI programs can identify and prevent error, inefficiency, and abuse across the system.