Fraud Management & Detection
Comprehensive fraud prevention, detection, and investigation system
System Active
Real-time Monitoring
Critical Alert
City Health Clinic (CR-345678) has been suspended due to severe fraud investigation. Risk Score: 92/100 | Investigation: INV-2024-089 | Amount: SR 125,000
Confirmed Fraud Rate
% of total financing volume
0.3%
Target: 0.5%
Good
Provider Denial Rate
Insurance claims denied
12%
Target: 15%
Good
Duplicate Claims Blocked
Duplicate attempts prevented
0.8%
Target: 1%
Good
Patient Verification Failures
Patients denying treatment
6.5%
Target: 5%
Warning
Fraud Rule Trigger Rate
Alerts generated
4.2%
Target: 5%
Good
Avg Investigation Time
Time to resolve cases
12 days
Target: 15 days
Good
Fraud Recovery Rate
Amount recovered
58%
Target: 50%
Good
High-Risk Provider Accounts
Risk score > 85
1.8%
Target: 2%
Good
Active Investigations
4
Total Amount: SR 210,500
High-Risk Providers
2
Risk Score ≥ 70 | Under Enhanced Monitoring
Alerts Today
4
Critical: 2 | High: 1