Advanced technology, reliability & industry expertise make us a trusted partner in payment integrity
Our philosophy is simple: combine superior service with cutting-edge analytics to combat healthcare claim losses. We empower payers to stay ahead in Payment Integrity, FWAE prevention and Cost Containment.
Our Mission
At Healthcare Fraud Shield, we believe honesty, trust, and education are essential to protecting healthcare. Our mission is to equip payers with AI-powered technology, expert insights, and flexible solutions to detect and prevent FWAE. We deliver measurable savings, improve payment integrity, and promote transparency.
Together, we’re creating a healthier, more trusted future for healthcare.
Our Subject Matter Experts
Certified to Deliver Results
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- Accredited Health Care Fraud Investigators (AHFI)
- Certified Professional Coders
| • CPC | • COC | • CCM |
| • CPC-P | • CRC | • CCM-P |
| • CPMA | • CPC-I | • CDC |
| • CDEO | • CEMC | |
| • CPCO | • CFPC |
Where Expertise Meets Education
Our team also routinely provide certification and educational training nationally for various organizations, including:
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- National Health Care Anti-Fraud Association (NHCAA)
- Association for Community Affiliated Plans (ACAP)
- American Academy of Professional Coders Local Chapters (AAPC)
- Health Plan Alliance (HPA)
- Healthcare Payment Integrity Congress (HPRI)
- and more
Meet Our Leadership Team
With over 20 years of experience developing and designing expert-based claims fraud, waste, abuse, and error detection systems, our in-house SIU team of accredited investigators and healthcare and software subject matter experts leverage leading-edge analytics, AI, and proprietary and external data for the most accurate claims analysis available.
Our Journey:
Innovating Payment Integrity from Day One
2011
Healthcare Fraud Shield is founded to deliver purpose-built technology for detecting and preventing FWAE.
2012
HCFSPlatform launches, giving payers an integrated platform for detection, case management and reporting.
2015
AIShield adds machine learning, bringing adaptive analytics to identify evolving fraud patterns.
2017
RxShield expands, offering deeper insight into prescribing behaviors during the height of the opioid crisis.
2019
We become fully cloud-native, offering secure, scalable and high-performing solutions for all lines of business.
2021
PreShield and AuditPlus launch, helping payers prevent improper payments and optimize audits.
2023
FWA360Leads delivers predictive lead scoring, prioritizing high-impact cases for SIUs.
2025
Healthcare Fraud Shield sees record client growth, becoming a go-to partner in payment integrity across Medicaid, Medicare and Commercial plans.
TODAY
Our modular HCFSPlatform continues to evolve, helping payers stay ahead with AI-driven tools, expert support and measurable results.