To build a better fraud trap
Minnesota companies Ingenix and Fair Isaac are each working on technology to help identify false claims that contribute to skyrocketing health-insurance costs.

BY JULIE FORSTER
Pioneer Press

Ferreting out intentional crime from a legitimate mistake or simply a difference in opinion between a doctor and insurer is not always black and white. *Robin Mathias*, a health care fraud consultant based in Santa Rosa, Calif., noted that while it is cutting edge, the technology is not as clear-cut when used to find health care fraud as it is in finding fraud in the credit card industry.

For one thing, it may be very limited in the type of fraud it can detect. “Predictive modeling is a great advance but it is still limited in the context of health care fraud detection,” *Mathias* said.