Harvard Pilgrim Health Care Selects Fair Isaac's Payment Optimizer To Detect Fraud And AbuseSAN RAFAEL, Calif., May 15, 2003 -- Fair Isaac Corporation (NYSE:FIC), the leading global provider of analytics and decision technology, today announced that non-profit health plan Harvard Pilgrim Health Care and Perot Systems Corporation, one of the largest providers of full-service information technology services and business solutions in the hospital industry, have selected Fair Isaac's Payment Optimizer solution to detect fraud and abuse. Harvard Pilgrim, which serves 765,000 members in Massachusetts, New Hampshire and Maine, outsourced both its claims processing and technology functions to Perot Systems Healthcare in October 1999 as part of its continual commitment to improve its existing claims and technology infrastructure. The addition of Fair Isaac's Payment Optimizer solution will enable Harvard Pilgrim to detect fraudulent and abusive patterns earlier and more accurately in their claims review process. Fraud and abuse continues to be a major concern to the healthcare industry, costing the nation as much as $100 billion a year according to the U.S. General Accounting Office. "Harvard Pilgrim and Perot Systems Healthcare are making successful inroads with the provider network to ensure that claims are submitted correctly," said Leanne Berge, Harvard Pilgrim's Senior Vice President for Provider Contracting and Operations. "With the successful level of claims processing, and at a time when skyrocketing costs are threatening the healthcare system, Harvard Pilgrim is redoubling its efforts to control fraud and abuse -- a major drain on financial resources that should be re-directed to actual care and services. By using Payment Optimizer, we will achieve early and accurate detection of potential fraud, the key to prevention and savings." Harvard Pilgrim has an extensive e-health IT program, utilizing automated technology and Web-enabled systems to speed up and simplify key transactions. Toward this end, Perot Systems Healthcare and Harvard Pilgrim were interested in a fraud detection system that would effectively detect fraud and abuse among the large number of claims it processes annually. Harvard Pilgrim and Perot Systems Healthcare have formed a top-notch Special Investigative Unit (SIU) that investigates potential fraud and abuse and r ecovers funds paid out inappropriately. The unit is responsible for extensive claims data mining; onsite investigations; training and educating members, providers and employees; participating in antifraud associations; and aggressive claims recovery and provider prosecution. Fair Isaac demonstrated its fraud detection capabilities by utilizing Harvard Pilgrim's claims data in a proof-of-concept program. The results clearly illustrated the ability of the Payment Optimizer solution to successfully detect fraudulent claims and improve bottom-line savings. "As healthcare increases in technical sophistication, so does its vulnerability to fraud," said Steve Biafore, Vice President of Healthcare Analytics at Fair Isaac. "In times of an economic downturn, many fraudsters try to take advantage of these vulnerabilities. Fair Isaac's Payment Optimizer solution was designed for highly accurate detection and actually reduces the number of 'false-positives,' or claims incorrectly flagged for investigation. It also provides payors with reason codes that identify risky and suspicious patterns, helping substantiate the fact that fraud has occurred." Payment Optimizer uses Fair Isaac's neural network technology, which has been successfully deployed in finding fraud in credit cards and other financial transactions. The software identifies patterns of unusual behavior and provides a score based on the claim's degree of risk. The score allows claims professionals to determine which claims need to be taken out of the payment stream for further investigation, and allows the rest of the claims to be fast-tracked for payment. The system also provides reason codes to help investigators determine the most appropriate action on each high-risk claim. It is sophisticated enough to discern between actual fraud and legitimate claims that may look like fraud. This accuracy translates into fewer unneeded investigations, less wasted resources, and ultimately, happier providers who do not receive unwarranted audits. About Fair Isaac: Fair Isaac Corporation (NYSE:FIC) is the preeminent provider of creative analytics that unlock value for people, businesses and industries. The company's predictive modeling, decision analysis, intelligence management, decision management systems and consulting services power more than 25 billion mission-critical customer decisions a year. Founded in 1956, Fair Isaac helps thousands of companies in over 60 countries acquire customers more efficiently, increase customer value, reduce fraud and credit losses , lower operating expenses and enter new markets more profitably. Most leading banks and credit card issuers rely on Fair Isaac solutions, as do insurers, retailers, telecommunications providers, healthcare organizations and government agencies. Through the www.myFICO.com Web site, consumers use the company's FICO(R) scores, the standard measure of credit risk, to manage their financial health. As of August 5, 2002, the business of HNC Software Inc., a leading provider of high-end analytic and decision man agement software, is part of Fair Isaac. For more information, visit www.fairisaac.com. About Harvard Pilgrim Health Care: Harvard Pilgrim Health Care is a not-for-profit health plan operating in Massachusetts, New Hampshire and Maine with a network of more than 22,000 doctors and 130 hospitals. Harvard Pilgrim provides innovative approaches to health improvement and disease management, unique online tools that speed and simplify key transactions for employers and providers, and personalized health support at www.harvardpilgrim.org. About Perot Systems Corporation: Perot Systems is a worldwide provider of information technology services and business solutions. Through its flexible and collaborative approach, Perot Systems integrates expertise from across the company to deliver custom solutions that enable clients to accelerate growth, streamline operations, and create new levels of customer value. Headquartered in Plano, Texas, Perot Systems has more than 400 clients and reported 2002 revenue of $1.3 billion. The company has more than 9,000 associates located in North America, Europe, and Asia. Perot Systems Healthcare is one of the largest providers of full-service IT operations in the hospital industry, managing significant relationships with four of the top 20 U.S. health systems. More than 4,000 employees from the Healthcare Industry Group serve both the for-profit and not-for-profit healthcare marketplace, providing integrated end-to-end technical and business solution services. Perot Systems healthcare clients represent more than 300 healthcare providers, thousands of caregivers, 200 health insurance organizations, as well as leading biopharmaceutical and healthcare supply chain companies. Additional information on Perot Systems is available at http://www.perotsystems.com. Fair Isaac Statement Concerning Forward-Looking Information: Except for historical information contained herein, the statements contained in this press release that relate to Fair Isaac, including statements regarding the future performance of its Payment Optimizer solution, are forward-looking statements within the meaning of the "safe harbor" provisions of the Private Securities Litigation Reform Act of 1995. These forward-looking statements are subject to risks and uncertainties that may cause actual results to differ materially, including any unforeseen technica l difficulties related to the use and functionality of Payment Optimizer, market acceptance of Payment Optimizer in general, the risk that customers will not perceive material benefits from the product, the product may fail to deliver the expected functionality, the general availability date of Payment Optimizer may be delayed due to unforeseen reasons; the company's ability to recruit and retain key technical and managerial personnel; the maintenance of its existing relationships with key alliance partner s; its ability to continue to develop new and enhanced products and services; competition; regulatory changes applicable to the use of consumer credit; and other data and other risks described from time to time in Fair Isaac's SEC reports, including its Annual Report on Form 10-K for the year ended September 30, 2002, and Form 10-Q for the period ended March 31, 2003. If any of these risks or uncertainties materializes or any of these assumptions proves incorrect, Fair Isaac's results could differ material ly from Fair Isaac's expectations in these statements. Fair Isaac disclaims any intent or obligation to update these forward-looking statements. Perot Systems Statement Concerning Forward-Looking Information: Statements contained within this press release may contain forward-looking statements, which involve risks and uncertainties that may cause actual results to vary from those contained in the forward-looking statements. In some cases, you can identify such forward-looking statements by terminology such as "may," "will," "could," "forecasts," "expects," "plans," "anticipates," "believes," "estimates," "predicts," "potential," or "continue." In evaluating all forward-looking statements, you should specificall y consider various factors that may cause actual results to vary from those contained in the forward-looking statements. In addition, Perot Systems results could be affected by risks and uncertainties, and you should specifically consider various factors that may cause actual results to vary from those contained in the forward-looking statements, such as: the loss of major clients; deterioration of project and consulting-based revenue and profit associated with deteriorating market conditions; Perot System s' ability to achieve future sales; changes in its UBS relationship and variability of revenue and expense associated with its largest customer; growing start-up businesses; the highly competitive market in which Perot Systems operates; the variability of quarterly operating results; changes in technology; and risks related to international operations. Please refer to the Perot Systems Annual Report on Form 10-K for the fiscal year ended December 31, 2002, as filed with the U.S. Securities and Exchange Com mission and available at www.sec.gov, for additional information regarding risk factors. Perot Systems disclaims any intention or obligation to revise any forward-looking statements whether as a result of new information, future developments, or otherwise. |