Artificial Intelligence for Healthcare Payment Integrity and the Prevention of Fraud, Waste, and Abuse

Advanced Healthcare AI

The WhiteHatAI Centaur is an advanced AI driven forensic tool examining every line of every claim quickly and accurately while learning from every interaction it has with skilled medical claims professionals.

Force Multiplier

Our Centaur healthcare AI amplifies the impact of subject matter experts, cost-effectively solving skilled labor shortages and dramatically increasing the effectiveness of skilled healthcare professionals.

Dashboard Analytics

The Centaur lists suspect issues through an easy to use summary framework and interface to help confirm, deny, or dispute claims charges.

The WhiteHatAI Centaur platform is a flexible, patent-pending automated healthcare fraud detection software platform that ingests electronic healthcare claims by the millions. The healthcare AI system quickly identifies medical abuse, fraudulent healthcare charges, and errors regardless of complexity. The system lists suspect issues and presents the data in clear visual and data formats, helping organizations appropriately address charges presented for payment.

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The healthcare fraud AI system continuously learns from human interaction. The Centaur’s ability to detect healthcare fraud, waste and abuse becomes stronger with every example of medical billing abuse it encounters.
Commercial Payers
The Centaur’s powerful AI engines work around the clock to audit millions of claims, independently adjusting to new data while preventing millions of dollars of potential fraud, waste and abuse.
Auditing Companies
The Centaur provides a tool to help shift from a rules-based fraud detection approach to a true AI solution that investigates every claim while increasing auditing output, volume and accuracy.
Medicare/Medicaid
The Centaur provides targeted, deep subject matter expertise to assist with medical claims fraud detection, claims reimbursement, preventing millions of dollars of fraud, waste, and abuse while uncovering potential criminal activity.
Self-Insured
Self-Insured payers are under unique financial pressures. The Centaur provides self-insured organizations with powerful fraud detection AI tools, producing a cost-effective alternative to traditional scaling methods.

FWA Detection Involving the Patient, Payer and Provider

WhiteHatAI, now a part of Sharecare, takes an industry-unique approach, working across the entire payment continuum from the patient to the provider to the payer, bringing a heavy dose of AI and data science to the healthcare fraud industry.

Our AI-based platform, the Centaur, is designed for healthcare payers to automatically and economically find past, present, and emerging healthcare claims fraud, waste, and abuse issues.

The Centaur works in harmony with installed solutions and utilizes patent-pending AI-based technology to uncover new insights and schemes not possible with traditional investigative processes and procedures, empowering payment integrity units with an unmatched investigation tool.

In an industry first, WhiteHatAI and Sharecare are connecting patients, providers, and payers to fight FWA and make healthcare “all together better.”

Highlights:

  • AWARDED 2019 Top 20 Cognitive Solutions (CIO Review Magazine)
  • PATENT PENDING blend of Advanced Analytics,  Artificial Intelligence, and NLP
  • ARTIFICIAL INTELLIGENCE for Pre-Submission, Pre-Payment, and Post-Payment
  • SCALABLE WORFORCE MULTIPLIER solves auditing and investigation resource issues
  • DESIGNED for Payers Deployment
  • INDEPENDENTLY initiates FWA Preventative Actions
  • LEARNS from its users as it is deployed becoming more and more accurate
  • ARCHITECTED FOR EASY INTEGRATION into existing FWA solutions