Healthcare Fraud Shield listed as a Sample Vendor for AI Enabled Fraud Detection in the Gartner® Hype Cycle™ for U.S. Healthcare Payers, 2025.
Gartner recommends Payers:
- Prioritize solutions that clearly articulate the use of AI algorithms and ML models to identify emerging fraud schemes. While AI capabilities are increasingly available, the right usage of AI algorithms differentiates vendor outcomes.
- Partner with operations peers for detailed documentation of your SIU procedures to prepare your organization for agentic-AI-augmented payment integrity opportunities.
- Review existing payment integrity capabilities and relationships before procuring additional modules to avoid redundancies across solutions. Consider partnering with current vendors to reduce vendor management strain if they meet your fraud solution criteria.
- Hold your vendor accountable with rigorous service-level agreement thresholds for accurate fraud identification metrics and by tracking false positive rates. Consider whether a cost savings or contingency model would be valuable for a postpayment recovery process or if a per-member-per-month pricing model would be easier to plan for annual costs.
Healthcare Fraud Shield is a one stop shop providing healthcare companies the tools they need to through both Prepayment and Postpayment and a combination of Artificial Intelligence, Advanced Analytics, Targeted Analytics and Shared Analytics across multi-payer data to:
- Prevent Fraud, Waste, Abuse and Error
- Reduce Costs
- Improve Claim Review Efficiency
- Manage Audit Workflows, Medical Record Retrieval and NLP
Discover how Healthcare Fraud Shield leverages advanced AI to enhance FWAE detection without replacing human expertise here: https://www.hcfraudshield.com/our-ai-advantage/
Gartner Clients can access the Hype Cycle for U.S. Healthcare Payers, 2025 at https://www.gartner.com/document-reader/document/6598902?
Gartner, Hype Cycle for U.S. Healthcare Payers, 2025, By Robert Potts, Connie Salgy, Austynn Eubank, 16 June 2025.
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