VSP is the largest vision healthcare provider in the US, providing products and services to eye-care professionals, employers, and more than 70 million members. VSP processes 25M claims every year.
Aviana developed anomaly detection algorithms to identify suspicious providers for the Special Investigative Units (SIU) as well as the Data-Warehousing group – deriving fraud indicators, controlling the fraud indicators for known or explainable causes, developing outlier metrics at the provider level, and combining the multiple outlier metrics to derive a provider fraud score.