The National Healthcare Anti-Fraud Association estimates that healthcare fraud annually costs the US about $68 billion. In 2020, out of the total $2.2 billion recovered by the government from False Claims Act cases across all industries, $1.8 billion has been received by The Department of Justice (DOJ) involving healthcare fraud and false claims. The fraud comes in many forms and must be addressed with new approaches.
To combat this escalating rate of healthcare fraud and protect citizens’ tax dollars from abuse, healthcare organizations are increasingly beginning to employ AI-powered tools. Algorithms like our Felix Payor Protection engine keep constant watch over the necessary data and help identify cost outliers compared to clinical cohorts as well as unusual billing patterns. The results enable both private payors (ACOs and commercial insurance companies) as well as government payors to detect potentially fraudulent billing behavior faster and accelerate their investigations. These recovered funds can then be utilized to provide care for beneficiaries.
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