Every year billions of dollars are lost to fraud, waste and abuse in Healthcare

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COVID-19 FWA  Schemes Report

30 page special report on emerging COVID-19 related FWA schemes

An AI-assisted platform that detects problematic claims and provider behavior early

Our comprehensive platform uses patented AI technology to detect problematic claims and empower your analysts and investigators to control costs. Our behavioral analysis and detection engine shows you recent provider behavior and claims patterns, and can detect new and emerging fraud schemes before they add up to a bit hit on your bottom line.

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  1. Insight Scope – Gives everyone across the health plan an easy way to research issues with self-service reporting and querying of claim, provider, facility and member behavior.

  2. Provider Scope – Compares each provider’s claims and coding practices to their peers, identifies outlier behavior, and proactively engages providers to improve claim integrity and bring down pre-claim costs with a provider self-monitoring and communication portal.

  3. Fraud Scope – AI automatically identifies new and emerging fraud schemes, streamlines collection of evidence chains, and gives SIU teams integrated case workflow for the investigations you choose to purse.

FraudScope - FWA Vigilance During The COVID-19 Pandemic

Fill out the form below to download our detailed report on how plans can protect themselves against new fraud, waste and abuse threats due to the COVID-19 pandemic.