Improving Workers’ Compensation Provider Fraud Detection

Elder Research automated fraud detection for a national Workers’ Compensation Insurance Program to optimize investigations and forensic analysis

Optimizing Federal Workers Compensation Claims Approval

Elder Research developed an automated risk assessment framework to triage Worker’s Compensation claims, prioritizing high risk cases for manual review.

Improving Unemployment Insurance Claim Fraud Detection

Elder Research built an automated fraud detection solution for NY DOL Unemployment Insurance Integrity Center of Excellence with annual savings of $1.4M

Improving Service Provider Performance and Patient Outcomes

Elder Research developed a provider risk scoring model for a major dental insurance provider that enabled targeted intervention with low quality providers and reduced per patient cost by nearly 25 percent.

Improving Credit Card Risk Scoring

Elder Research was hired to improve the performance of the client’s world-class credit card default risk model using modern machine learning techniques.

Detecting Healthcare Insurance Fraud, Waste, and Abuse

The goal for this project was to identify and quantify fraud, waste, and abuse indicators for a Medicare and Medicaid Dental Insurance client so that they could rank potentially fraudulent providers and target them for appropriate interventions.

Prioritizing Building Lease Renewal Risk

Elder Research created a risk model to help the USPS-OIG prioritize facility lease review to focus on facilities with the highest risk or financial impact.

Detecting Fraudulent Workers’ Compensation Claims

Department of Labor OIG wanted to detect fraud in Office of Workers’ Compensation Program data. The goals were to highlight abnormalities in the claims data that could be used for future audits and to create visualization tools to allow auditors to easily explore potentially fraudulent claims.

Prioritizing Long-Term Care Claims

Elder Research developed a risk scoring model to optimize management of long-term care claims and identify those most likely to benefit from outreach.

Reducing Contract and Claims Fraud, Waste, and Abuse

Elder Research developed and deployed a custom solution to identify and prioritize questionable contracts and healthcare claims for fraud investigation.

Reducing Service Provider and Warranty Fraud

Elder Research designed and deployed an automated fraud detection system credited with saving over $67 million in service provider and warranty fraud.

Text Mining Audit Reports to Determine Grant Recipient Risk

Elder Research built an end-to-end text mining and document classification solution in the client’s AWS cloud to extract CPA Findings from audit reports.

Validating A Predictive Model of Maritime Casualty Risk

Elder Research validated the methodologies used by RightShip to develop Qi, a new model to enhance maritime safety by predicting the ship casualty risk.

Automating Data Pipelines and Network Entity Detection

Elder Research developed an automated data pipeline and a data visualization tool used to explore document preparer network relationships. Forty percent of the cases being investigated were automated, reducing case investigation from 20 minutes per case to less than a minute per case.