Discover how Healthcare Fraud Shield leverages advanced AI to enhance FWAE detection without replacing human expertise.
Our AI-powered platform delivers faster, more accurate detection while empowering investigators, not replacing them.
Why AI? Why Now?
The volume and complexity of healthcare claims continue to rise. Identifying FWAE manually is no longer sustainable. That’s where AI shines.
AI can analyze millions of claims in seconds.
It identifies suspicious patterns too complex for traditional rules.
It enhances the reach and efficiency of your SIU/PI teams.
AI That Drives Results You Can Measure
Faster, more accurate detection: Triage potential cases in minutes, not days, while reducing false positives.
Greater efficiency: Automate repetitive reviews and free your investigators for higher-value work.
Stronger ROI: Catch more fraud, recover more dollars, and prevent future losses through predictive insights.
AI as an Assistant, Not a Replacement
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Our AI supports, not replaces, human decision-makers. |
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It automates the repetitive, time-consuming tasks so your team can focus on complex cases. |
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Every HCFS solution is designed with a human-in-the-loop model for oversight and control. |
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Investigators tell us AI makes their work more impactful—not obsolete. |
Trust Is Built Into Our Technology
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Explainable scoring: Clear logic behind every AI-generated lead or alert. |
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Built-in compliance: Designed to meet healthcare regulations and audit standards. |
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Human oversight: You stay in control with transparent workflows and full visibility. |
AI in Action: HCFS Solutions at Work
Detects suspicious billing and utilization patterns across vast datasets.
Applies machine learning to post-pay claims for recovery opportunities.
Uses targeted analytics and AI to identify questionable prescribing behavior.
