Healthcare Fraud Shield was founded in 2011 to offer innovative fraud, waste, and abuse (FWA) solutions to healthcare insurance payers.
The focus of Healthcare Fraud Shield is solely on healthcare fraud prevention and payment integrity with a successful approach based on many unique advantages we deliver to our clients.
Healthcare Fraud Shield’s fraud, waste, and abuse platform – FWAShield™ – is an integrated solution consisting of PreShield™ (pre-payment), PostShield™ (post-payment), RxShield™ (pharmacy analytics), CaseShield™ (case management), and QueryShield™ (ad-hoc querying tool).
FWAShield™ was developed by industry leading healthcare subject matter experts with the latest technology available today, including the most affordable, flexible, transparent, efficient, and effective solution in the marketplace.
HCFS was founded by Mike Moseler and Steve Halper, pioneers of successful fraud detection software companies in the financial services industry. They have over 20 years of experience in developing and designing expert-based fraud detection systems that leverage leading edge analytics, AI, and best exterior data, resulting in superior FWA identification rates.
HCFS also provides the best-in-class services related to the detection and verification of suspected FWA billed services, including inappropriately billed claims and the development of claim edit rules for claim processing systems.
HCFS has an experienced SIU team, including leading subject matter experts in the healthcare industry that are part of the team that designs and develops our software suite. The HCFS SIU team includes Accredited Health Care Fraud Investigators (AHFI) as well as Certified Professional Coders (CPC, CPC-P, and CPC-H), and routinely provides training nationally for various organizations, including the NHCAA.
Our team’s extensive expertise has been leveraged to provide best-in-class services related to the detection and verification of suspected FWA billed services, including inappropriately billed claims and the development of claim edit rules for claim processing systems.
HCFS has a simple philosophy – careful attention to detail, superior service, advanced predictive analytics, built-in fraud investigator intelligence, and flexible solutions tailored to meet the changing needs of each individual client.