Healthcare Fraud Shield Brings AI to Healthcare Fraud Detection

What You Should Know:

• Healthcare Fraud Shield (HCFS), a leading provider of fraud, waste, abuse, and error (FWAE) protection solutions for the healthcare insurance market, today launched FWA360Leads, a new product that automatically identifies and prioritizes FWA leads based on order of importance and impact severity.
• The HCFS PlatformTM is the backbone of many top healthcare insurance companies’ FWA & payment integrity strategies – delivering millions of dollars in savings, recoveries, and prevented losses each year.

Revolutionizing Healthcare Insurance with AI-Powered Fraud Detection

Healthcare insurance companies face constraints in resources and time when identifying, qualifying, and accepting new leads for Fraud, Waste, and Abuse (FWA) cases, whether for pre-pay reviews or post-pay assessments. To address this challenge, HCFS has introduced FWA360LeadsTM as an automated solution within the workflow of healthcare plans, seamlessly integrated into HCFS’s FWA Precision EngineTM. This innovative tool utilizes AI models, including machine learning, to detect, present, review, and accept leads, optimizing the process and providing several business benefits:

1. Enhanced lead value by combining Artificial Intelligence with HCFS’s extensive library of over 1000 alerts.

2. Reduced false positives and improved precision and accuracy through machine learning.

3. Increased operational efficiency, leading to resource savings.

The system proactively identifies and prioritizes high-risk cases through early detection in pre-payment scenarios, offering actionable intelligence for immediate responses such as pre-payment measures, provider education, and case prioritization.

“We’re thrilled that early healthcare insurance company users of FWA360LeadsTM have reported high ROI from the product,” said Karen Weintraub, EVP, HCFS. “Namely, they are now able to both eliminate tedious manual analytics and identify new important leads that they would otherwise have likely missed. This product represents the ongoing evolution of HCFS, always seeking to leverage the latest technological innovations in pursuit of protecting our customers from FWA and providing them millions in savings that they would otherwise never recover.

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machine learning
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