FraudScope’s AI-Assisted Platform Saves Tens of Millions for its Health Plan Customers as They Combat Fraud, Waste, and Abuse

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AI-Driven Solution Spurs Growth, New Product Functionality, and Better Outcomes.

By staying on the forefront of new and emerging capabilities in the AI industry, we are be able to out-innovate our competition and deliver the best results possible for our customers.

FraudScope, an AI-assisted platform that helps health plan special investigations units, payment integrity, and medical review teams investigate fraud, waste, and abuse (FWA), today announced substantial growth in 2019 allowing it to analyze claims for more than 24 million lives. This was due to significant expansion work at FraudScope’s existing health plan customers and the addition of several new customers in 2019. FraudScope was able to help its health plan customers realize tens of millions of dollars in fraud, waste, and abuse identifications and savings in 2019.

FraudScope also continued to innovate and expand offerings throughout 2019, including the addition of new capabilities for facility and pharmacy FWA detection and investigation; a ‘collusion’ capability that helps plans identify cases where patients, providers, facilities and/or pharmacies are colluding to commit FWA; and more than 75 customer-driven enhancements. Health plans now have the ability to proactively identify emerging fraud, waste, and abuse schemes quickly in these areas to help them minimize exposure.

“I attribute our landmark growth to our extraordinary team focused on customer-centric innovation,” stated Musheer Ahmed, CEO of FraudScope. “We always keep the customer at the center of everything we do and are finding new ways to leverage cutting edge artificial intelligence to combat fraud and abuse. This is something our team is passionate about which sets us apart.”

In addition to its superior innovation and analytics capabilities, FraudScope has worked to implement aggressive project turnaround times for its customers, with most experiencing an average deployment time of around six weeks, and less than four weeks for turnaround on customer-requested enhancements.

“AI is helping automatically identify cases of fraud, waste, and abuse that otherwise would have been missed or required significant man-hours to detect just a couple of years ago,” continued Ahmed. “By staying on the forefront of new and emerging capabilities in the AI industry, we are be able to out-innovate our competition and deliver the best results possible for our customers.”

FraudScope customers are seeing dramatic results such as an ROI of more than 20:1. One customer experienced a 50 percent increase in investigator productivity, 40 percent more cases identified compared to other solutions, and a 93 percent reduction in false positive cases. More information about FraudScope solutions can be found at https://www.fraudscope.com/solutions/.

About FraudScope
FraudScope is an AI-assisted platform that accelerates the identification of fraud, waste, and abuse. Our comprehensive claims investigation platform utilizes proven and patented AI-based technology to empower investigators and analysts to derive insights and conduct full investigations of suspect claims. For additional information about FraudScope and our solutions, visit https://www.fraudscope.com/.

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David Grice
FraudScope
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