Case Study: PRO BTP detects suspicious health claims in real time with IBM fraud management solutions

Analytical tools used for real-time detection of suspicious claims for medical expenses

Pro BTP, a social security provider for France's construction and civil engineering industries, faced the challenge of only detecting fraudulent medical expense claims after they had been paid. Partnering with IBM, they sought a smarter solution to identify and stop suspicious optical and dental reimbursements before payment was issued to better control expenses and reduce system abuses.

IBM developed a secure service platform named Solon, which utilized enriched predictive models and self-learning technology to analyze claims in real time. This IBM solution successfully identified new fraud patterns during its proof of concept, flagging 9% of optical and 14% of dental claims as suspicious. The implementation will help Pro BTP avoid paying fraudulent claims while speeding up legitimate payments, resulting in significant future cost avoidance.

Pro BTP

Paul Grasset

Chief Executive Officer