Aetna said its fraud-detection software helped it prevent more than $89 million in fraudulent reimbursements from being paid last year, compared with $15 million it was able to recover after fraudulent payments were already made. Companies are able to save far more money by detecting fraud before claims are paid than recovering the money after the fact. Mike Stergio of Aetna noted that the majority of medical providers are honest. "The hard part is finding [fraudulent providers] among all these good people and at the same time not branding everyone out there as bad".

Fraud accounts for an estimated 3% to 10% of the $2 trillion spent annually on health care in the U.S. Companies have developed software that detects suspicious patterns in claims data. A method called "spider-webbing" finds one common denominator and follows the thread. Red flags indicating possible fraud include medical providers charging more than peers; providers who administer more tests or procedures per patient; providers who conduct medically unlikely procedures; providers who bill for more expensive procedures and equipment when there are cheaper options; and patients who travel long distances for treatment.

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