Mastercard entry helps providers and payers cut fraud, protect data

Mastercard is rolling out a suite of products to help healthcare organizations to detect fraud, waste and abuse, capture more revenue and protect patient data.

The corporation plays a big role in the healthcare industry by helping providers, insurers and other entities enable their employees with access to healthcare funds via flexible spending accounts, health savings accounts and health reimbursement arrangement cards.

Now, the company also offers tools to help providers improve patient receivables, patient assurance, payment integrity and cybersecurity. Unlike other entrants, Mastercard will enhance a partner’s business and not compete with them, the company vows.

The company’s product suite further includes a platform to help health systems optimize billing with predictive analytics that consider a patient’s unique circumstance, use of artificial intelligence and machine learning to detect suspicious claims activity, and biometrics and behavioral analytics to protect health information.

A major focus for Mastercard will be to aggressively address fraud, waste and abuse, which is a $240 billion problem annually, says Marie Aloisi, senior vice president of the Mastercard health division in North America. “Mastercard brings technology to an industry 15 years behind,” she asserts.

Mastercard itself thwarts 1 billion fraudulent transactions each day while facing 200 attacks daily, she adds.


The company is taking its artificial intelligence tools and retraining the modules to identify waste and abuse to help payers look at claims prior to adjudication and determine if the claims are appropriate. “We also look at providers for prior signs of abuse before adjudicating a claim,” Aloisi says.

Mastercard is working with hospitals and other providers on how to handle patients with high deductible health plans and ways to get more out-of-pocket payments from these patients, and it’s also helping providers learn how to become collection agencies and use credit scoring models and predictive analytics to segment patient populations and determine their propensity to pay.

With data breaches doubling so far in 2019 and 31 million records already breached, Mastercard further is helping providers and payers adopt digital authentication, which is biometric proof that a person is the person they claim to be and then authenticate the data to make sure it’s not hackable.

“We’re not here to disrupt but to partner with providers and payers to help patients lead healthy lives,” Aloisi concludes.