Healthcare Fraud Shield

AIShield Overview
Healthcare fraud, waste and abuse (FWA) schemes morph as new codes are developed, and in response to existing rules and edits designed to prevent risk. AIShield® is an artificial intelligence platform that is fully integrated with FWAShield® to efficiently detect complex schemes by leveraging both supervised and unsupervised modeling techniques. AIShield® was designed and validated using known healthcare FWA cases for superior prediction capability and accuracy.

CaseShield Overview
Our unique case management system, which can be integrated with our other products or utilized on a standalone basis, assists in automating many of the manual tasks associated with the typical healthcare fraud case workflow.

FWA360Leads Overview
FWA360Leads is a NEW user experience designed to automate the identification of leads that are of the highest value for review for potential FWAE. FWA360Leads combines the power of Artificial Intelligence (AI) and our extensive library of alerts in summary form using Natural Language Generation along with AI explanations. FWA360Leads will learn from user feedback to automatically recalibrate the feed based on AI models that learn over time both the company and individual user preferences.

FWAShield Overview
Healthcare Fraud Shield offers a fully integrated fraud, waste, and abuse (FWA) software solution platform called FWAShield. It utilizes unique and proprietary data sources to maximize Return on Investment (ROI) and achieve superior results. Our platform is deployed utilizing a Software-as-a-Service model which allows us to quickly adopt new system enhancements and fraud analytics with minimal work for our customers.

PostShield Overview
Healthcare Fraud Shield's innovative PostShield® contains powerful fraud rules and algorithms developed by industry experts who understand the essentials of fraud detection and prevention. With an estimated 3-10% of claims dollars misappropriated due to fraud, waste, and abuse (FWA), it is essential to monitor claims from every phase of the claim cycle.

PreShield Overview
Individuals and companies in the healthcare industry are finding new and innovative ways to commit fraud, take public and private money and then disappear. While the traditional retrospective investigative approach is still an integral and necessary function, stopping fraudulent claims before they are paid is vital in impacting the growing fraud crisis.

QueryShield Overview
Healthcare Fraud Shield has developed a powerful ad-hoc querying tool that works seamlessly throughout FWAShield®. QueryShield® enables a user to run real-time queries and complex pattern reports from data loaded into PreShield®, PostShield® and/or CaseShield®.

RxShield Overview
As pharmacy expenditures rise, pharmacy fraud, waste, and abuse (FWA) continue to be a prevalent issue for both commercial and government payers. RxShield® is fully integrated with PreShield®, PostShield®, QueryShield® and CaseShield®.

SIU Services Overview
Insurance companies today face the challenge of protecting their network against fraud, waste, and abuse while not adversely impacting their Medical Loss Ratio (MLR). Moreover, Special Investigation Units (SIU) face reduced budgets and increasingly strained resources. Fully outsourcing or partially outsourcing components of SIU responsibilities serve as a solution to the budgetary constraints.

Recording: Imitation is the sincerest form of Fraud?
Healthcare Fraud Shield will walk attendees through the uncovering of a case of billing for services not rendered, using the emergency room for non-emergent services and impersonation in the hopes of pushing payments along.