Healthcare fraud in the United States costs an estimated $68 billion annually and contributes to rising healthcare costs. Common abuse of the system includes upcoding and unbundling of services, billing for services never rendered and using stolen healthcare data to file fraudulent claims.
In response to this problem, two researchers from Georgia Institute of Technology’s cybersecurity department, Dr. Musheer Ahmed and Dr. Mustaque Ahamad, developed an AI-based platform called FraudScope. The platform uses a proactive technology to automatically identify fraud schemes, including new and emerging ones. In addition to this, FraudScope stands apart as its sophisticated detection technology can be used to identify suspicious activity before claims are paid which helps maximize savings.
The FraudScope team received an award from the Coulter Translational Program during our 2016-2017 funding cycle. The funding and operational guidance provided by the Coulter Team aided in getting them start-up ready in six months, effectively reducing their development timeline by half. Dr. Ahmed noted that, “The interest, energy and focus of key skill sets around our project allowed us to move forward very quickly in a 6 month interval to potential industry partners.”
Fraudscope was founded in 2017 and in that same year successfully raised over $1.6 million in venture capital investments to assist with scaling customer acquisition and expanding product development. FraudScope currently has engagements at several large commercial health plans and has proven successful in identifying fraud schemes associated with health insurance claims.
To learn more about the FraudScope technology, visit fraud-scope.com.