Healthcare Fraud
The Fraud We All Pay For!
Healthcare Fraud Detection
Neural Networks
With advanced Neural Networking, we find fraud where others can't!
HIPAA Compliant
Your privacy and the privacy of your Plan Participants is very important to us!
Pattern Detection
Patterns evolve in Big Data. Finding the patterns in behavioral analytics is the key to finding the fraud.
Big Data
The use of Big Data in Healthcare claims is an integral part to detecting fraud on a macro level.
We are Healthcare Fraud Specialists
We specialize in post paid insurance claims fraud, including Medicare and Medicaid claims. This is an over $350 Billion industry that has largely been left unchecked...until now!
The Individual
Individual consumers are defrauded as fraudulent charges move through the medical system, resulting in higher premiums for everyone.
The Public
Bad actors are allowed to erode the public’s trust in the medical community.
The Company
Companies suffer up to 3% reduced profitability as they cover a portion of health insurance premium costs.
The Company
Increased risk of Sarbanes-Oxley violations as these frauds and criminal acts are now discoverable.
Are there any long term effects from fraud?
Absolutely!!!
Cost growth in medicine is driven by multiple problems.
Fraud is a major cause, as the costs are transferred to the general population through increases in insurance premiums, provider charges and taxes.
Waste and abuse is another major cause. Many medical providers game the system by charging the absolute maximum amount insurance will allow. This drives the insurance companies to increase premiums due to the increasing provider charges.
Why put your trust in us?
Our suite of detection models are developed in collaboration with experts on the front lines of the medical, audit, data science and law communities.
We regularly add new algorithms based upon advances in data science, including Machine Learning (ML) and Artificial Intelligence (AI) techniques.
Our models are built on our patented critical decision making methodologies.
Are there tools that our customers can use to see what is happening in their back yard?
Of course!
Powered with industry leading Business Intelligence analytical software, The M42 Fraud Detection tool allows you to analyze your own health insurance post-paid claims datasets.
The embedded algorithms are focused on finding fraud, waste and abuse in big data sets.
The customer portal provides a simple user experience.
Your data will not cross any international borders as we are completely US staffed and based.
Ready to get started?
M42 is a Software as a Service (Saas) platform that empowers its users through specialized AI and ML technology to identify difficult to find insights.