Hidden in your data flow are the signals of fraud, waste, and abuse.

Opera's machine intelligence brings them to the forefront, so you can bring them to an end.

Fraud, waste, and abuse don't just spring up overnight. They unfold as a pattern of behavior, over time. So to find them, you need to be able to look through a massive river of data as it flows, and find those temporal patterns and anomalies.

In concept, it's simple. In execution, it's not. You must have a powerful signals library to understand what data is important to monitor, what to look for in that data, and what patterns indicate a problem. You need advanced models and algorithms to find those patterns and anomalies. A processing platform that's powerful enough to accurately extract these patterns from the huge, ongoing data flow created by millions of individuals and a wide range of data sources. And a way to integrate this intelligence into your day-to-day operations, so that you can stop more bad actors earlier.

This is what Opera's family of Waste, Fraud, and Abuse solutions offers. Our solutions in Financial Services Fraud, Healthcare Waste, Fraud, and Abuse, and Hospital Revenue Leakage are built on our Vektor™ Big Data analytics and signal processing platform. So they're end-to-end, ready-to-implement solutions that combine advanced pattern and anomaly detection analytics, high-volume processing of Big Data flows, and rapid, no-noise, low-investment integration into your existing operations.

Instead of losing sleep over frauds, let Opera be the fraudsters' worst nightmare.

This may sound obvious, but fraudulent acts in the financial arena are different from legitimate ones. And that's all we need to know to stop them.

Opera's solutions for financial services fraud take on bust-outs, merchant point of compromise, and ACH and wire transfer with advanced anomaly detection models and an extensive signal library. We evaluate both user and peer group behaviors, distinguishing normal patterns from ones that might indicate criminal activity. And we continually learn from the results, keeping you one step ahead of the criminals. (Our fraud analytics are so powerful, in fact, that ACI — one of the largest payments solutions providers in the world — is partnering with us to bring them to their customers.)

Better analytics are critically important, but they're just the first step. Next, you need a way to monitor an ongoing flow of very large and diverse data to find fraud patterns as they unfold over time. In other words, you need our Multichannel Fraud Mitigation Engine. It's built on our Vektor™ platform, combining massive Big Data signal-processing capabilities with seamless and rapid integration into your existing operations.

MULTICHANNEL FRAUD MITIGATION ENGINE


The Multichannel Fraud Mitigation Engine allows organizations to insert highly advanced fraud analytics into their operations with low disruption and minimal additional IT or infrastructure investment.
Better signals, better models, and a low-noise way to rapidly integrate ongoing fraud alerts and guidance into your operations. The result: we can find more bust-out, point of compromise, and wire fraud — and find it sooner — than existing approaches. Click on the links below to learn more.

Healthcare waste, fraud, and abuse aren't healthy for anyone.

We think it's time for a new course of treatment.

Healthcare Waste, Fraud, and Abuse (W/F/A) hurts the financial health of payers and law-abiding citizens alike. Fraud is a $100B problem in the US alone. But by marrying Opera's advanced analytics capabilities with an experienced leadership team, we are focused on making a fundamental dent in this industry-wide problem.

Our team's track record of success in delivering pioneering capabilities to address healthcare W/F/A goes back over a decade. We have served clients in Medicare, Medicaid, and commercial settings, across medical, pharmacy, and dental activity.

What does this experience tell us? We believe there's a big opportunity in taking the best practices from consumer finance and applying them to healthcare W/F/A. Just as almost every financial transaction is scored in real-time for fraud risk, we're building the capability to prospectively score each claim for overpayment risk. It's a paradigm shift that's long overdue: deploying detection prior to payment so that the industry can shift from the existing pay-and-chase approach to a more preventive course of treatment.

Our approach draws on Opera's of experience in finding W/F/A through pattern and anomaly detection. Our Healthcare Solution uses advanced signals detection and models, including:

1. Holistic Predictive Analytics. Assessments of claims and providers that simultaneously consider many factors, not just one or two rules.
2. Self-Revealing Data-Driven Approaches. Using analytics to find hidden patterns and correlations in the data to complement our rules-based approaches that capture years of the Opera team's experiences.
3. Sophisticated Anomaly Detection. Advanced approaches to find "Day Zero" frauds — that is, newly emerging patterns of abuse never before seen.
4. Actionable Results. Models that operationalize algorithms by creating reason codes to ensure that model output is transparent and understandable.

We are creating not only the analytics, but also the capability to deploy those analytics in your operations, with easy-to-use review interfaces. And, because this capability is built on Opera's Vektor™ Big Data analytics and signals processing platform, it handles large and complex data flows with ease, and integrates into your operations quickly with little organizational disruption.

We think it's time for a paradigm shift. And we're using our capabilities to create it.

You need more than a simple bandage to stop most hospitals' revenue bleeding.

You need Opera's Hospital Revenue Leakage Solution.

With invoices stretching to dozens of pages or more, simple billing can often seem as complex as major surgery. And as with surgery, omissions, errors, and duplicated procedures can be extremely costly. Simple rules-based models can stanch some of the flow, but what they miss, and the false positives they generate, can drain a hospital's coffers.

Fortunately, Opera's Hospital Revenue Leakage solution is always on call. We use advanced analytics and the unlimited capacity of machine intelligence to help hospital business offices systematically evaluate large amounts of data to pinpoint errors and missing charges.

Advanced clustering algorithms create groups of similar invoices. Powerful anomaly detection models find invoices that differ from their clusters, and pinpoint specifically what's missing. We integrate this capability directly into a hospital's existing systems and ensure it constantly recalibrates to meet changing needs.

It's just what the doctor ordered for both inpatient and outpatient billing procedures — the ideal medicine for hospitals looking to bill correctly, insurers looking to find erroneous line items, and laboratories and other critical suppliers looking to get their billing right.

And we're getting very positive outcomes. For our client hospitals, in fact, we've identified leakage equaling as much as 2% of their total revenues.