The Centaur: Humans and Machines Helping Each Other Find Fraud

Fraudsters are sophisticated criminals, changing their tactics nearly every day. To combat this kind of threat, the Sharecare Centaur augments human analytic capabilities by capitalizing on the strengths of machine analysis while avoiding the risks of purely automated approaches. Sharecare Payment Integrity’s approach to this kind of human-computer symbiosis was inspired by lessons learned from years of medical fraud work.

The Centaur uses a unique blend of patent-pending AI architecture and trade secret technology to find and isolate potential medical fraud and waste BEFORE a medical bill is paid. The human analysts, in turn, interacts with the system and uses their intuition, experience, and domain knowledge in identifying and responding to subtle cues, edge cases, and new indicators of evolving medical fraud tactics to help “teach” the Centaur system. A bit of this intuition and experience is transferred to the Centaur every time one of these interactions take place.

The Centaur looks across an entire universe of data to find blatant and novel patterns of suspicious activity while working in symphony with its human partner. The Centaur works in harmony with Investigators, tapping into their contextual knowledge to know where to look for medical fraud, waste and abuse. Sharecare Payment Integrity’s analytical applications enable experts to interact with the data in ways explicitly designed for fighting fraud.

Once the Centaur has identified and characterized a new pattern of medical fraudulent behavior, the Centaur system can quickly recognize all cases that conform to this pattern, enabling an organization to take swift action to eliminate the threat caused by complex attributes or behaviors discovered in the course of investigation BEFORE a check is cut.

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