Medical Fraud Detection Software With Artificial Intelligence

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

The Centaur 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, dispute or renegotiate healthcare claims charges.

The WhiteHatAI Centaur system is a flexible, patent-pending automated anti-healthcare fraud software platform that ingests electronic healthcare claims by the millions. The 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 WhiteHatAI Centaur 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 Medicare fraud detection, claims reimbursement, and 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

Post Pay and Prepay Working Together

The WhitehatAI Team: Experience Across the Healthcare Industry

The WhiteHatAI team brings unmatched expertise in claims adjudication platforms for major commercial payers, Medicare, Medicaid, providers billing systems, and a heavy dose of AI and Data Science to the healthcare fraud industry.  This expertise allows WhiteHatAI to approach the fraud, waste, and abuse problem in healthcare with an eye on outcomes, relationships, and value-based care that results in industry disruptive innovation.

For years the healthcare industry has been focused on post payment analytics, utilizing big data platforms that have proven to be unable to stop the growth of healthcare FWA.  In fact, the FWA problem is now growing faster than the healthcare industry itself. The wrong tools combined with a lack of FWA staff and resources make the FWA problem more and more challenging every day. And armed only with inefficient systems, investigators and auditors watch helplessly as huge numbers of fraud suspects continue to steal billions of dollars from the U.S. healthcare system.

WhiteHatAI takes a different approach, working across the entire payment continuum from provider to prepay detection and prevention to post payment analytics.  Our FWA platform, the Centaur, learns from all interactions before, during and after claims payment.  The Centaur adjusts and creates dynamic data models while accepting manual changes on demand.  We call this a “collective intelligence”, a powerful tool when looking not only across a payer/provider ecosystem but also across the industry for payment integrity issues.

WhiteHatAI has created the learning Centaur technology that is easy to deploy and creates a force multiplier effect on existing resources.  The Centaur can scale infinitely to meet any volume of claims and patient encounters, acting as “Active Artificial Intelligence” that is capable of acting on healthcare claims in the same way a skilled auditor would.

Highlights:

  • Advanced algorithms that pinpoint FWA issues
  • Automatically identifies denials and presents suspects for validation
  • Not rules-based however the Centaur’s AI has learned 1000’s of rules
  • Active AI that augments your labor force with an army of AI auditors
  • Almost immediate Return on Investment (ROI)
  • PREPAY and POSTPAY working in harmony
  • Hybrid Dynamic Learning: Supervised and Unsupervised
  • More than an analytics tool for auditors to use; the Centaur is a fast, smart auditor trained by and for your orginization