Anti-fraud software solution, Netmap, has seen success in South African transport parastatal Transnet, recovering about R3 million per annum in fraudulent medical aid claims.
Netmap is a software system designed by Alta and based on an Informix database, which discovers suspicious patterns and trends that are invisible to human scrutiny.
"Netmap is designed for companies that record a high volume of transactions regularly. It can sift through data and detect even three-phase patterns that would otherwise go unnoticed," says Transnet`s Group Audit Services GM Nigel Payne.
The United Kingdom Dental Practice Board has used the system to discover claims for pregnant men, multiple claims for the same patient, and claims for out-of-hours re-opening of the same surgery more than ten times in one day.
Knowledge Integration Dynamics (KID), local distributor and support centre for Netmap and other Alta products, is now targeting the product at similar users in SA - specifically the medical and dental market.
"The Alta and Informix solution provides medical aid companies with an invaluable advantage in the fight against fraudulent and inappropriate claims. The solution pays for itself quickly by ensuring that any suspicious data is quickly detected," says Paul van der Merwe, director of KID.
Outsourcing options are available from KID, which has made its IT infrastructure available to companies that are potentially exposed to fraud and want their data examined, but do not want to spend the money buying the infrastructure and skills.
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