FraudScope

Industry: Healthcare fraud and abuse prevention

FraudScope has developed a system for detecting billing fraud, waste and abuse in the healthcare industry.

Healthcare fraud is estimated at a cost of $272 billion annually, most of it never recovered. With FraudScope’s patented technology, health insurance companies can detect fraud faster and more precisely, saving customers and taxpayers money.

The company’s competitors use either rule-based systems or supervised machine learning to detect fraud, and they take months to deploy. By contrast, FraudScope uses “unsupervised” machine learning to identify new fraud schemes and translate a risk score into actionable steps.

The AI-assisted platform offers an intuitive and easy-to-use suite of investigative tools, with built-in collaborative workflow tools like automated reminders, screen sharing and custom permissions. The proactive AI uses professional claims data to identify providers and facilities associated with fraud and other suspicious claims.

This system has already identified a billion dollars’ worth of fraudulent claims. 

Company website: FraudScope

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