Case Study: Medical Claim, Fraud Prevention and Detection

The Client

The customer is one of the global top leading consulting firms engaged in business of provisioning, inter-alia, consulting services to its clients.

Business Needs

Healthcare currently suffers from physician or clinician errors, hackers, or issues of the same electronic health record (EHR) not being properly updated that causes patients subject to physical, mental, and financial damages.

Blockchain helps to rectify all of these as all parties would be responsible for maintaining security and integrity. This would present healthcare with a single source of truth that parties share

Solutions

  • Providers submit medical claims with supporting documents via Blockchain-based system.
  • The system automatically exercise smart contracts for reimbursement.
  • For complex claims, fraud detection system validates suspected facts.

The Benefits

  • To reduce redundancies across the entire industry
  • To manage healthcare payments more trustily
  • To make medical history accurate and available for prompt treatment
  • To support fraud detection