NHA partners SAS for fraud detection & prevention


SAS India is partnering with National Health Authority (NHA), a government body that implements India’s flagship public health insurance or assurance scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). The scheme is the world’s largest health assurance scheme that caters to a health cover of Rs. 5 lakhs per family every year in order to meet the secondary and tertiary care hospitalization to poor and vulnerable families across the country.

SAS will provide data analytics for NHA’s National Anti-Fraud Unit (NAFU) to identify any fraudulent activities rises in the implementation structure of the scheme.

Along with the Fraud Analytics Control and Tracking System (FACTS) of NHA, SAS extends its hands to prevent the fraudulent activities through a health-care specific fraud and abuse data model that encapsulates data from both internal and external sources. SAS, therefore, helps NHA to meet its objective of detecting and minimizing health care fraud using advanced analytics.

Managing Director and VP of SAS India Noshin Kagalwalla said that catering health care assistance to all poor and vulnerable families across the country is a complex process. But then, backing up data with analytics can be useful. The main aim of NHA’s FACTS project is to detect and minimize health care fraudulent activities with the help of advanced analytics. SAS software will also provide information about the patients who are served under the PM-JAY scheme.

The software provides an end-to-end framework with specific components for fraud detection, alert management, and case handling for NHA.

Chief Executive Officer of National Health Authority Dr. Indu Bhushan said that NHA is proud to select and have SAS to support in analyzing the disparate data sets related to health care administration. The selection of SAS is after the six-month-long concept exercise from among five to global analytics firm participation. NHA will deploy data analytics to identify inconsistencies and detect and prevent fraudulent activities.

SAS’ fraud analytics engine for NHA’s FACTS uses various techniques to discover the probability of fraud for health insurance schemes. The various techniques are automated business rules, outlier analysis, predictive modeling, text mining, database searches, exception reporting, and network link analysis.

The analytics engine could also be used with artificial intelligence (AI) and machine learning (ML) algorithms to identify and prevent fraud across India for the scheme.


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