Anti-Fraud Enterprise Solution (AFES)
For the prevention and recovery of fraud, waste, and abuse
With fraudsters endlessly plotting to work around existing rules and models, fraud, waste, and abuse (FWA) schemes are continuously changing. To keep pace, organizations must find alternative ways to combat FWA effectively.
- Redefine your approach to FWA
- Key features of AFES
- Is your organization a good candidate for AFES?
- Get in touch
- Join the conversation
Redefine your approach to FWA
Adopting a broader, technology-enabled, end-to-end solution for FWA prevention and recovery—one that's focused on pre-emptive detection and mitigation—can help organizations more efficiently and effectively manage fraud control at the front end of the payer workflow.
In addition to preventing a FWA payment before it happens, an effective approach to FWA can enable organizations to decrease investigative and detection costs while increasing recovery.
Companies can also benefit from a solution that:
- Prioritizes cases leading to actionable outcomes
- Increases the number of new pre-payment edits implemented to deliver cost avoidance
- Raises the dollar amount recovered
That’s where Deloitte can help.
Simply put, AFES is changing the way organizations approach FWA prevention and recovery. AFES leverages our distinct Managed Risk Services operating platform and delivery model, combined with the global scale of our anti-fraud and FWA prevention knowledge and experience.
This deep knowledge is critical to continuously improve industry benchmarked models and rules through analysis, enhancement, and tailoring by our industry specialists to client specific profiles and requirements over time. Equally important is our demonstrated process enhancement, as well as a powerful, ever-evolving technology solution to focus on preemptive detection and mitigation.
The bottom line? AFES can help organizations fortify their FWA prevention and recovery initiatives with high levels of operational and system integration, data integrity, scalability, and performance.
Key features of AFES
Our skilled and experienced professionals will be there throughout the entire journey to:
- Recommend new or improved compliance rules to provide a more thorough and effective analysis of data, using analytic results to support policy recommendations or help identify loopholes to be mitigated
- Identify potential unknown fraud risks more quickly and thoroughly through our specialists and machine learning, which can highlight and help address outliers and anomalies
- Continuously improve analysis of FWA claims through ongoing monitoring, both pre-and post-claim, by proactively detecting non-compliant or potentially fraudulent behavior
- Generate soft notices to help deter continued fraudulent behavior, typically in one of three areas:
- A significant billing outlier
- An emerging trend
- A policy violation
- Reduce costs to recovery while increasing recovery rates via targeted, high return on investment investigations
Is your organization a good candidate for AFES?
A few questions to consider:
- Do you have an understanding of the financial impact to your company/organization from unresolved FWA?
- How effective is your organization's current FWA approach? What are your most critical FWA challenges?
- How quickly and thoroughly are you able to identify potential unknown fraud risks in the FWA process?
- How well does your current FWA approach support resource requirements relating to investigators, inspectors, auditors, and prosecutors? How are you currently managing any resource limitations?
- How well are you prepared organizationally to support future mandates, regulations, and emerging technologies?
Analytics preventing fraud, waste, and abuse in benefits programs