Latest innovation identifies new risk vectors from emerging schemes and behaviors
Healthcare Fraud Shield (HCFS) is excited to announce the innovative new feature AIShield to its flagship FWAShield platform. Supplementing its powerful rules-based system, HCFS embeds AI technology to provide compelling and reliable insights into emerging fraud, waste and abuse schemes. FWAShield includes PreShield, PostShield, RxShield, CaseShield and QueryShield which leverage a robust logic engine that evaluates over 800 rules for known FWA behaviors. Together with the introduction of AIShield, it provides a seamless digital experience that delivers richer insights and automated workflows for healthcare payers. The introduction of AIShield simplifies the complexities of identifying new and emerging behaviors that were previously unknown to investigators.
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Karen Weintraub, Executive Vice President, explains, “Combating healthcare fraud is an ever-evolving challenge of identifying morphing behaviors and new fraud schemes using extraordinary large datasets. AIShield provides our clients an enhanced capability that directly supports established techniques in solving their tough challenges.” Mike Moseler, Chief Technology Officer further explains, “By incorporating supervised and unsupervised AI models into ensemble models we provide more advanced decision and action support than ever before, while complementing existing payer toolsets.” HCFS’s SIU team has over 200 years of combined experience in fraud, waste and abuse investigations and has leveraged their work by developing retroactively-tested and proven models to accurately detect known fraud, waste and abuse leads. By integrating both machine-learning and investigator validation and data collection, AIShield delivers increased efficiencies and capabilities to a plan’s program integrity efforts while significantly reducing false positives.
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About Healthcare Fraud Shield
Healthcare Fraud Shield, a HITRUST certified company, is one of the fastest growing providers of FWA systems in the healthcare industry. Customers who implement the FWAShield suite of SaaS products realized millions of dollars in savings, prevented certain types of fraud, and benefited from productivity and workflow improvements. The company founders and core development team previously pioneered the automated FWA systems in the banking and finance industry, creating two of the leading solutions still in use today. By combining this cutting-edge technology with the most knowledgeable health care fraud prevention experts, Healthcare Fraud Shield is acknowledged as the most innovative and effective solution in the market today.
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