Healthcare fraud, waste and abuse schemes morph as new codes are developed, and in response to existing rules and edits designed to prevent risk. AIShield is an artificial intelligence platform that is fully integrated with FWAShield to efficiently detect complex schemes by leveraging both supervised and unsupervised modeling techniques.  AIShield was designed and validated using known healthcare fraud, waste and abuse cases for superior prediction capability and accuracy.

AIShield Desktop
  • Data Visualization: The model results are presented in a highly intuitive UI that enables end users to quickly see and interact with the data to isolate on the providers of highest interest.
  • Natural Language Generation: As an industry first of its kind, a summary is generated for each provider. In simple language, it tells the story of the behaviors.
  • Integration: The AIShield platform is fully integrated with FWAShield. With a single mouse click, the end user can begin navigating the existing platform, and quickly research the provider in more detail.
  • SME: The methodology, the UI and all aspects of this new approach were the result of a team of subject matter experts across Product Development, Healthcare Fraud Investigations, SIU Executive Leadership, Data Science and Engineering to deliver an intuitive, easy-to-use solution.
  • Technology: We leverage best in class technology to enable highly complex data modeling on big data efficiently.

View Full AIShield Product Sheet

Additional Healthcare Fraud Shield Products and Services

An integrated fraud, waste, and abuse solution that utilizes unique and proprietary data sources to maximize Return on Investment (ROI) and achieve superior results.

A pre-payment solution to reduce dollars lost from payment of ineligible claims.

A post-payment solution to monitor claims and suspicious activities.

A pharmacy analytics solution to identify improperly billed prescription drugs.

An ad-hoc tool to run real-time queries and complex pattern reports from loaded data.

A case management solution to automate reporting, tracking, and communications.

Expert analysis of claims, development of cases, and detection of systemic weaknesses.