Risk management optimization

Leverage our extensive experience in fraud and abuse management, identity fraud, customs risk management and tax audit and compliance.

"Insider attacks" represent an emerging security threat for business. As software becomes more secure, computer users will continue to be the weak link for an organization, and criminals will focus more efforts on convincing end users to execute the attack instead of wasting time in lengthy software vulnerability discovery. Read about Identity Risk and Investigation Solution below.

IBM has extensive experience in developing solutions that deploy early-warning analytics to detect potential fraud and abuse, allowing companies to respond to problems faster and more cost effectively.

The CBO announces the Risk Identification Analysis Service - An innovative service giving you access to the power of advanced data mining and analysis techniques.

Billions of dollars in revenue are lost each year by business and government due to fraud and abuse. The issue is particularly acute in the areas of health care and tax reporting. Estimates of loss, for example, in the area of health care alone amount to more than $100 billion annually according to the National Health Care Anti-Fraud Association .

Detecting fraudulent activity is not easy, with many organizations relying on "pay-and-chase" strategies, in which possible offenders are often pursued and investigated years after the fact — if at all. Recognizing the ultimate impact fraud and abuse has on business, government and individual citizens, IBM has developed solutions to respond to this challenge.

• The IBM Fraud and Abuse Management System (PDF, 200KB) supports the various aspects of fraud investigation and management, including prevention, investigation, detection and settlement. Using a unique combination of data mining capabilities and graphical reporting tools, the system can identify potentially fraudulent and abusive behavior before a claim is paid or retrospectivel y analyze providers’ past behaviors to flag suspicious patterns.
• The Risk Identification Analysis Service (PDF, 180KB) is designed to bring the full range of the IBM Fraud and Abuse Management System capabilities to even the smallest of organizations, delivering powerful detection, investigation, settlement and prevention services to healthcare organizations. As a service, IBM consultants and technology analyze the claims data that you provide, rank providers based on their behaviors and provide you with actionable reports as an enhancement to existing audit processes. These powerful reports will enable auditors to investigate the providers, institutions, suppliers, and other entities that may be engaging in aberrant practices.
• The IBM Tax Audit and Compliance System (PDF, 189KB) gives tax auditors the power and flexibility to build new compliance models to close the tax gap as taxpayers find new and innovative ways to evade taxation. It was designed for and with tax auditors to help them perform complex tasks quickly and more precisely.
• The IBM Identity Risk and Investigation Solution (PDF, 122KB) is a comprehensive fraud detection and prevention solution. It is designed to extend an organization's on-line security measures beyond existing user verification processes to include session-based behavioral analysis. This solution combines the power of advanced analytics and data mining to assess deviations in behavior by comparing access patterns exhibited by the user during a session against the patterns of prior sessions and peer groups of similar users.
• The IBM P&C Loss Analysis and Warning Solution (PDF, 128KB) is designed to help protec t P&C insurance companies from illegal and unethical activities by policyholders, agents, service providers (e.g., auto repair shops) and employees. These a ctivities can result in inflated claims payments, higher than necessary supplier costs and loss of premiums. The solution provides P&C insurers with the means to analyze their claims data and warn them of possible cases of fraud and abuse. The solution is adaptable to nearly all areas of P&C insurance and is compatible with the IBM Insurance Information Warehouse.
• The IBM Customs Risk Management System assists government officials with the identification of potentially fraudulent customs declarations on goods shipped from country to country.

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