AI, predictive analytics, consortium data at forefront of fraud fight, says SAS on Fraud Week
Though the exact toll is immeasurable, fraud losses drain about 5% of a typical organisation’s annual revenues, estimates the Association of Certified Fraud Examiners (ACFE). Applied to last year’s gross world product of $84.84 trillion, that equals an astounding $4.24 trillion stolen, swindled or otherwise usurped in 2018 – the equivalent of $11.6 billion looted from the global economy each day.
To spotlight the critical role of anti-fraud technology, analytics leader SAS sponsors International Fraud Awareness Week, Nov. 17-23. The ACFE-led campaign aims to reduce the immense business and personal impacts of this criminal pandemic through awareness and education, including these live and on-demand webinars:
- One Step Ahead: Fight Fraudsters With Cutting-Edge Technology, Tuesday, Nov. 19 at 11 a.m. ET. Hosted by SAS with Intel and Capgemini, ACFE President and CEO Bruce Dorris will moderate a panel of experts exploring anticipated trends, challenges and best practices for integrating anti-fraud technologies.
- Managing Risk in the Age of Fraud, Friday, Nov. 22 at 3 p.m. ET. Exclusive to ACFE members, this webinar will convene FinServ fraud experts from SAS alongside Mary Ann Miller, Head of Fraud Strategy at Varo Money; and Frank McKenna, author of the blog Frank on Fraud, and co-founder and Chief Fraud Strategist of PointPredictive. Topics include 2020’s top fraud trends and the vital importance of artificial intelligence (AI) and predictive analytics to drive digital transformation.
“The techniques used by cybercriminals and organised crime groups are growing increasingly sophisticated. That’s why SAS is taking steps to ensure that banks, insurers and other organisations can use advanced analytics to keep ahead of the agile fraudsters of the digital age,” said Alex Boothroyd, Senior Banking Fraud Solutions Specialist at SAS UK & Ireland. ” The SAS suite of solutions provides organisations with full visibility of fraud risks, leveraging AI and predictive analytics to pre-emptively detect emerging threats, both known and unknown.”
SAS readies launch of new digital identity and authentication offering
As digital transformation accelerates, the matter of identity and authentication has emerged among the most pressing fraud issues. Is the person transacting on the other side of that computer or smart device who they claim to be? Banks, insurers, telecommunications firms and retailers have mere seconds to answer that question, even as online identities have become more malleable and spoofable than ever.
SAS® Identity Enrichment and Assessment will soon debut as a software-as-a-service (SaaS) offering. Powered by SAS Analytics, it harnesses the deep intelligence of consortium data – identity data crowdsourced from multiple providers – to deliver rapid, centralised authentication of digital users.
“Authentication measures can be an ongoing thorn in the side for organisations of all size, who need to strike the balance between security and providing a seamless customer experience,” said SAS’ Boothroyd. “Organisations need to have a thorough understanding of true identity if they are to succeed in preventing fraud. SAS solutions can provide this by sifting through large volumes of multi-spectrum data from industry-leading providers, encompassing digital identity, biometrics, telephony data, public records, fraud scoring and more.”
The forthcoming offering is just the latest in an arsenal of fraud-fighting analytics solutions helping SAS customers outpace the bad guys.
UK Insurance provider Admiral fights fraud with AI
Fraudulent claims and applications are a major problem for the UK insurance industry, with both insurers and genuine customers paying the price through increased premiums. According to Cifas, the UK’s leading fraud-prevention service, false insurance claims rose by 27% in 2018 from the previous year, with auto/motor seeing a 45% increase.
Admiral, a UK-based insurance company, has developed fraud portals that eliminate the need for manual referrals, saving significant time and resources while detecting more fraud than ever before. Fraud investigators and analysts now work from a single centralised hub, sharing data across the organisation and applying sophisticated analytics to detect and prevent fraud. This approach has delivered more than £31 million of benefit in the last 12 months alone, including £6 million in savings for claims fraud.
“We used an insurance fraud analytical engine from SAS to apply multiple techniques – including automated business rules, machine learning, artificial intelligence, text mining, database searches, anomaly detection and network-link analysis – to automatically score claims, associated entities and any corresponding social networks,” explained Sarah Lang, Head of Business Analytics at Admiral. “This process has allowed us to build a strong relationship between analytics and claims fraud. A continuous feedback loop ensures we continue to update the process, identifying fraud in more cases in a faster way, whilst improving our customers’ experience.”
Detecting fraud, waste and abuse in prescription drug claims
Health care fraud costs insurers between $70 billion and $234 billion each year. Prime Therapeutics is fighting back with an initiative that saved the 23 Blue Cross Blue Shield plans it serves $279 million in the first year.
Last fall, Prime became the first pharmacy benefits manager (PBM) to integrate pharmacy and medical drug claims with medical service data in a comprehensive anti-fraud platform. Prime’s new SAS platform delivers a holistic, total drug management view: data from members, prescribers and pharmacies, fully integrated together. That complete data picture combined with the platform’s robust AI and machine learning capabilities enables Prime to detect fraud, waste and abuse (FWA) regardless of cause or source.
“While many PBMs and health plans have facets of these data, it is the integration of the data – and the complete picture it creates – that powered our early success,” said Jo-Ellen Abou Nader, Vice President of FWA and Supply Chain Optimisation at Prime. “In 2019 alone, Prime investigators referred 721 cases involving activities by doctors, patients and pharmacies to payers based on insights from the SAS platform and our new approach to detection and prevention.”
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