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Stop Opioid Prescription Fraud (via a Decision Support System)

Situation

A national healthcare agency processes all prescription insurance claims for the country’s healthcare market with a set of applications on HPE NonStop systems. The agency is facing exponential growth in the number of prescriptions due to an aging population along with prescription fraud and abuse.

Problem

  1. A new integrated system was needed to allow filling valid prescriptions, while identifying and flagging fraudulent prescription and reimbursement requests.
  2. The agency was tasked with minimizing opioid addiction and abuse, yet, due to privacy laws, various jurisdictions maintained data silos, which made it difficult to consolidate data for analysis.

Solution

Use HPE Shadowbase Data Integration to integrate the claims processing application with a prescription fraud Decision Support System (DSS).

Fraud detection

Figure 1 — Real-Time Fraud Detection Architecture

Outcomes

HPE Shadowbase Products of Interest


Contact us or your HPE Shadowbase representative, and learn how Shadowbase software will benefit you.

Further Reading

Related Case Study: Prescription Drug Fraud Prevention — An HPE Shadowbase Data Integration Case Study

Related White Paper: HPE Shadowbase Streams for Data Integration

Related Solution Brief: HPE Shadowbase Data Replication Solutions

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