Large organisations often hold substantial volumes of information, but identifying hidden patterns of fraud, irregularity and financial exposure requires more than traditional review processes. By combining advanced data analytics with digital intelligence and investigative capability, organisations can identify risk at a scale that would otherwise be difficult to achieve.
Castor Vali was engaged by a government health department in Southern Africa to support the assessment of a large portfolio of medical malpractice claims. The objective was to identify claims requiring further investigation, reduce financial exposure and improve the efficiency of the claims review process.
The Challenge
The client was managing thousands of active medical malpractice claims, representing significant contingent liabilities. Manual review processes made it increasingly difficult to identify duplicate submissions, organised fraud and hidden relationships between claimants, legal representatives and other connected parties.
The department required a scalable, evidence-led approach that could rapidly identify higher-risk claims while allowing legitimate claims to progress more efficiently.
The Approach
Castor Vali combined its Discovery analytics platform with Digital Pulse and investigative resources to analyse the claims portfolio from multiple perspectives.
Discovery was used to integrate and analyse multiple datasets, including government records and external reference sources such as property records, criminal data, corporate registries and medical benchmarks. Custom analytical models identified anomalies based on factors including claim values, geographic relationships and repeated patterns of activity.
Digital Pulse complemented this analysis by conducting open-source digital intelligence and social media profiling of selected individuals and entities. This provided additional context, supported identity verification and helped identify relationships that were not visible through structured datasets alone.
The combined intelligence enabled investigators to:
- identify potential duplicate and anomalous claims
- map relationships between claimants, legal representatives and medical facilities
- prioritise higher-risk cases for further investigation
- support verification through targeted investigative enquiries where required
The Outcome
During a six-month assessment of part of the overall claims portfolio, the combined analytical and digital intelligence approach identified approximately US$5 billion of claims that warranted further investigation due to indicators of potential fraud or irregularity.
The project enabled the client to:
- prioritise investigative resources towards higher-risk claims
- reduce potential financial exposure by reviewing flagged claims before settlement
- improve operational efficiency by allowing lower-risk claims to progress more quickly
- embed analytical models and risk indicators into future claims assessment processes
Applying the Same Capability Across Sectors
Although this engagement focused on medical malpractice claims, the same analytical approach can be applied wherever organisations need to assess large volumes of information for evidence of fraud, financial crime, misconduct or other forms of irregularity.
By combining Discovery’s data analytics with the digital intelligence capabilities of Digital Pulse, supported by experienced investigators, Castor Vali helps organisations move beyond manual review processes, providing evidence-based insights that support better decision-making, more targeted investigations and stronger risk management.
