FICO Insurance Fraud Manager 3.3 adds link analysis, facility model to boost detection of fraud rings and suspicious providers MINNEAPOLIS, Oct. 2, 2012 -- /PRNewswire/ -- FICO (NYSE:FICO), the leading provider of predictive analytics and decision management technology, today released the latest version of FICO® Insurance Fraud Manager, the most advanced system for detecting and preventing healthcare insurance fraud, waste and abuse. FICO® Insurance Fraud Manager 3.3 integrates link analysis with business rules and predictive analytics, and also adds a facility model for detecting fraud at a hospital or an outpatient provider. "Fraud has always been a part of the insurance business, but the magnitude of insurance fraud today is startling," said Russ Schreiber, who leads FICO's insurance practice. "Experts estimate the annual cost of health care fraud, waste and abuse in the US to be upwards of $700 billion, and last May one Medicare fraud scam alone racked up $452 million. Now, with FICO Insurance Fraud Manager 3.3, insurers have a better way to fight back." FICO Insurance Fraud Manager 3.3 boasts the first fully integrated link analysis capability with an insurance fraud application. Insurers who previously had to configure separate link analysis tools can now save time and improve results with an easy-to-use solution preconfigured to use health care claims data. With FICO Insurance Fraud Manager 3.3, insurers can investigate organized fraud rings using the visualization capabilities of a proven link analysis tool set, and easily create displays that reveal connections between disparate claims, patients and providers. "Integrating link analysis with Insurance Fraud Manager's powerful analytics and our advanced business rules gives insurers three ways to combat fraud, waste and abuse," said James Evans, vice president of network and financial management at McKesson Health Solutions, which provides Insurance Fraud Manager's analytics to U.S. insurers via its InvestiClaim® solution. "This triple protection gives insurers a powerful tool for fighting fraud, waste and abuse." The new facility model in FICO® Insurance Fraud Manager 3.3 scans enormous volumes of claims data for recurring, suspicious activity at a hospital or an outpatient provider. Telltale signs may include unusual scheduling with a single patient, unusually expensive procedures, and even such issues as patients being discharged and readmitted, which can indicate problems with quality of care. Universal American, which piloted this model with FICO, received a 2012 FICO Decision Management Award this month for its use of FICO Insurance Fraud Manager to control costs and prevent fraud losses. Universal American, a leading provider of health benefits to people with Medicare, has implemented the FICO Insurance Fraud Manager solution into their claims workflow prior to payment, and integrated it with their claims platform, Facets.

1. BP Holdings
FICO UNLEASHES NEW ANALYTICS
FOR FIGHTING AMERICA'S $700+
BILLION HEALTHCARE FRAUD,
WASTE AND ABUSE PROBLEM

2. FICO Insurance Fraud Manager 3.3 adds link
analysis, facility model to boost detection of
fraud rings and suspicious providers
 MINNEAPOLIS, Oct. 2, 2012 -- /PRNewswire/ -- FICO
(NYSE:FICO), the leading provider of predictive
analytics and decision management technology,
today released the latest version of FICO® Insurance
Fraud Manager, the most advanced system for
detecting and preventing healthcare insurance fraud,
waste and abuse. FICO® Insurance Fraud Manager 3.3
integrates link analysis with business rules and
predictive analytics, and also adds a facility model
for detecting fraud at a hospital or an outpatient
provider.
2

3. "Fraud has always been a part of the insurance
business, but the magnitude of insurance fraud today is
startling," said Russ Schreiber, who leads FICO's
insurance practice. "Experts estimate the annual cost
of health care fraud, waste and abuse in the US to be
upwards of $700 billion, and last May one Medicare
fraud scam alone racked up $452 million. Now, with
FICO Insurance Fraud Manager 3.3, insurers have a
better way to fight back.” FICO Insurance Fraud
Manager 3.3 boasts the first fully integrated link
analysis capability with an insurance fraud application.
Insurers who previously had to configure separate link
analysis tools can now save time and improve results
with an easy-to-use solution preconfigured to use
health care claims data.
3

4. With FICO Insurance Fraud Manager 3.3, insurers can
investigate organized fraud rings using the
visualization capabilities of a proven link analysis tool
set, and easily create displays that reveal connections
between disparate claims, patients and providers.
"Integrating link analysis with Insurance Fraud
Manager's powerful analytics and our advanced
business rules gives insurers three ways to combat
fraud, waste and abuse," said James Evans, vice
president of network and financial management at
McKesson Health Solutions, which provides Insurance
Fraud Manager's analytics to U.S. insurers via its
InvestiClaim® solution. "This triple protection gives
insurers a powerful tool for fighting fraud, waste and
abuse."
4

5. The new facility model in FICO® Insurance Fraud
Manager 3.3 scans enormous volumes of claims data for
recurring, suspicious activity at a hospital or an
outpatient provider. Telltale signs may include unusual
scheduling with a single patient, unusually expensive
procedures, and even such issues as patients being
discharged and readmitted, which can indicate
problems with quality of care. Universal American,
which piloted this model with FICO, received a 2012
FICO Decision Management Award this month for its use
of FICO Insurance Fraud Manager to control costs and
prevent fraud losses. Universal American, a leading
provider of health benefits to people with Medicare,
has implemented the FICO Insurance Fraud Manager
solution into their
5

6. claims workflow prior to payment, and integrated it
with their claims platform, Facets. "One key to success
in stopping inappropriate billing is to identify such bills
before they are paid," Tyrina Blomer, Medicare
Compliance Officer at Universal American, said of the
FICO Insurance Fraud Manager Solution. "We were able
to identify and prevent $6 million in inappropriate
billing over an 18-month period.” FICO Insurance Fraud
Manager detects fraud, abuse and errors in health care
claims and identifies suspicious providers as soon as
aberrant behavior patterns emerge. Providers can
accelerate claims processing while saving money by
avoiding improper payments, increasing loss recovery
and correcting systemic vulnerabilities. Staff
productivity increases via the system's ability to
6

7. prioritize work, rank-ordering claims by most
egregious and most financially significant. FICO
Insurance Fraud Manager now scores claims from
doctors, ancillary providers, pharmacies and health
care facilities, as well as detecting fraudulent
patterns associated with specific medical providers,
pharmacies and dentists. About FICO FICO
(NYSE:FICO) delivers superior predictive analytics
solutions that drive smarter decisions. The
company's groundbreaking use of mathematics to
predict consumer behavior has transformed
entire industries and revolutionized the way risk
is managed and products are marketed. FICO's
innovative solutions include the FICO® Score —
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8. the standard measure of consumer credit risk in the
United States — along with industry-leading solutions
for managing credit accounts, identifying and
minimizing the impact of fraud, and customizing
consumer offers with pinpoint accuracy. Most of the
world's top banks, as well as leading insurers,
retailers, pharmaceutical companies and government
agencies, rely on FICO solutions to accelerate growth,
control risk, boost profits and meet regulatory and
competitive demands. FICO also helps millions of
individuals manage their personal credit health
through www.myFICO.com. Learn more at
www.fico.com. FICO: Make every decision count™.
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9. For FICO news and media resources, visit www.fico.com/news.
• Statement Concerning Forward-Looking Information
Except for historical information contained
herein, the statements contained in this news release
that relate to FICO or its business 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 the
success of the Company's Decision Management
strategy and reengineering plan, the maintenance of
its existing relationships and ability to create new
relationships with customers and key alliance
9

10. partners, its ability to continue to develop new and
enhanced products and services, its ability to recruit
and retain key technical and managerial personnel,
competition, regulatory changes applicable to the
use of consumer credit and other data, the failure to
realize the anticipated benefits of any acquisitions,
continuing material adverse developments in global
economic conditions, and other risks described from
time to time in FICO's SEC reports, including its
Annual Report on Form 10-K for the year ended
September 30, 2011 and its last quarterly report on
Form 10-Q for the period ended June 30, 2012. If any
of these risks or uncertainties materializes, FICO's
results could differ materially from its expectations.
10

11. FICO disclaims any intent or obligation to update
these forward-looking statements.
FICO and "Make every decision count" are
trademarks or registered trademarks of Fair Isaac
Corporation in the United States and in other
countries.
-SOURCE FICO
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