Codoxo

FraudScope is a rapidly growing AI-based platform. FraudScope uses innovative data analysis techniques to prioritize suspicious medical insurance claims for investigation, aiming to save losses caused by fraud, waste, and abuse. The company is now closer to realizing its vision of becoming an AI-based collaborative platform that integrates across fraud, payment integrity, clinical, and provider network teams to reduce costs and improve the efficiency of health plans.The technology for detecting high-risk claims, which FraudScope has applied for a patent for, was developed by researchers at the Georgia Institute of Technology. Using data obtained from the Centers for Medicare & Medicaid Services (CMS), FraudScope is able to automatically uncover many recently reported high-value Medicare fraud cases, which were previously identified with the help of whistleblowers.