Nallan C Suresh

Title: Nallan C Suresh: Innovator in Healthcare Fraud Detection

Introduction

Nallan C Suresh is a prominent inventor based in Irvine, CA, known for his significant contributions to the field of healthcare fraud detection. With a total of 5 patents to his name, Suresh has developed innovative solutions that address critical issues in payment coding practices within healthcare systems.

Latest Patents

One of Suresh's latest patents focuses on the "Detection of upcoding and code gaming fraud and abuse in prospective payment healthcare systems." This invention enables the detection of fraud at various levels of the hierarchical coded payment system using an unsupervised model. The model analyzes variables and profiles created at different levels to provide a comprehensive overview of payment coding activities. By comparing these activities with those of peer entities, it identifies unusual and potentially inappropriate behaviors.

Another notable patent is the "Consistency modeling of healthcare claims to detect fraud and abuse." This approach utilizes transaction-based behavioral profiling to assess inconsistencies in an entity's activities, which can indicate fraudulent behavior. By examining service-code information from transactions, Suresh's method measures consistency and identifies patterns that may suggest fraud. Although the primary focus is on healthcare, the techniques developed can be applied across various industries.

Career Highlights

Nallan C Suresh has made a significant impact in his role at Fair Isaac Corporation, where he continues to innovate in the realm of fraud detection. His work has not only advanced the understanding of fraud in healthcare but has also paved the way for applications in other sectors.

Collaborations

Throughout his career, Suresh has collaborated with notable colleagues, including Anu Kumar Pathria and Jean De Traversay. These partnerships have contributed to the development of his groundbreaking patents and have fostered a collaborative environment for innovation.

Conclusion

Nallan C Suresh stands out as a key figure in the fight against healthcare fraud through his innovative patents and collaborative efforts. His work continues to influence the industry and offers valuable insights into improving payment coding practices.