Fraud Analytics and Detection Software (FADS)

Healthcare has become a major expenditure in the U.S. since 1980. In 2020, NHE grew to $4.1 trillion, accounting for 21% of the U.S. GDP. However, the size of the healthcare sector and the enormous volume of money involved have made it an attractive fraud target.

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Throughout the years, healthcare fraud detection has been relying on either the experience of domain experts, who manually review and identify the suspicious claims, or basic rule-based computer-aided systems with very limited capabilities as they focus on low-level schemes (e.g., incomplete data input, duplicate claims, and non-covered services). Those schemes represent nearly 12% of the total money lost to healthcare fraud. With nearly 290 million people insured in the U.S. and over 120 million payment transactions per day, those efforts has become erroneous enough, expensive, time consuming, and their impact is marginal at best.

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