Blog - Insights from the Frontlines

Deep dives into healthcare fraud detection, AI innovation, and program integrity insights from our team.

Which MOR Is This? A Surprisingly Expensive Question

Published: July 23, 2026
Author: Dr. Prince Baawuah
Head of Medicare Advantage Solutions

CMS ships the monthly and the annual final Model Output Report with byte-identical record layouts — the only thing distinguishing them is the dataset name, and that name rarely survives the parse. Stack the files together and you double-count risk scores. Deduplicate them and you may delete the settled year-end scores outright. The fix is two date fields read in the right direction.

Published: July 22, 2026
Author: Evan Brociner
Data Product Lead

A plain-language walkthrough of how Medicare overpayments happen, who becomes liable once one is identified, and why contestations—the flip side of overpayment—are a recovery opportunity most risk-bearing orgs leave on the table.

Published: May 19, 2026
Author: Yubin Park
PhD, Co-Founder

Enterprise organizations with OpenAI or Anthropic accounts can now connect their LLM platforms directly to Falcon's proprietary healthcare data—and seamlessly hand off to Falcon for deeper investigation without losing context.

Published: April 30, 2026
Author: Yubin Park
Co-Founder / CTO

The first in our research brief series. Medicare spending on urinary catheter codes A4352 and A4353 jumped roughly 20x in two years — and ACOs absorbed the cost. Download the full white paper.

Published: March 30, 2026
Author: Yubin Park
Co-Founder / CTO

Most ACOs sit on claims data that could surface millions in billing irregularities — but lack a clear strategy for acting on it. Here's how structured, evidence-based outreach gets providers to self-correct without formal enforcement.

Published: March 19, 2026
Author: Dr. Prince Baawuah & Yubin Park
Head of Medicare Advantage Solutions & PhD, Co-Founder

Medicare Advantage membership is a moving target — Medicaid eligibility shifts, CMS databases lag, and if you miss a rejection without proactively reaching out, the loss is yours. We built the Transaction Monitor so plans can stay on top of every enrollment transaction, year-round.

Published: February 12, 2026
Author: Yubin Park
PhD, Co-Founder

New Pulse Landscape views and Web Search Agent give you instant access to thousands of facilities and providers across ACOs, FQHCs, and SNFs — powered by public and proprietary data sources.

Published: January 18, 2026
Author: Yubin Park
Co-Founder / CTO

Why we're building AI that starts as your conversational partner and evolves into the autonomous intelligence layer running your healthcare operations. The gap in the market, what we're learning, and where this is all heading.

Published: December 29, 2025
Author: Yubin Park
PhD, Co-Founder

Load specialized healthcare knowledge, SQL templates, and analytical frameworks into your AI conversations. Skills transform complex domain expertise into reusable, shareable building blocks.

Published: December 18, 2025
Author: Yubin Park
PhD, Co-Founder

Set up recurring AI-powered reports delivered daily, weekly, or monthly. Turn your one-time data pulls into automated workflows that keep your team informed.

Published: November 11, 2025
Author: Yubin Park
PhD, Co-Founder

Get started with Falcon Health in three simple steps. From signing in to exploring Sentinel and Pulse, we'll show you the way.

Published: November 6, 2025
Author: Yubin Park
Co-Founder / CTO

Introducing Pulse & Sentinel v0.0.14—the first step in our vision to eliminate coordination overhead. When lean, expert teams can execute directly without handoffs, healthcare analytics moves at the speed of thought.

Published: October 24, 2025
Author: Yubin Park
Co-Founder / CTO

Introducing Pulse & Sentinel v0.0.13—removing the three fundamental bottlenecks in healthcare analytics: opaque AI, fragmented data, and technical barriers. Now with transparent tool usage, unified data access, and automatic visualization generation.

Published: October 23, 2025
Author: Yubin Park
Co-Founder / CTO

To effectively combat healthcare fraud, we need to think like fraudsters. Learn how understanding fraudster tactics (from timing and threshold gaming to identity manipulation) reveals critical system vulnerabilities and enables more effective fraud detection.

Published: October 17, 2025
Author: Yubin Park
Co-Founder / CTO

Most healthcare data platforms make you jump through hoops before you can evaluate if they're right for you. We think that's backwards. Now you can try Pulse, Scope, and Sentinel (all three products) with just an email address.

Published: September 1, 2025
Author: Yubin Park
Co-Founder / CTO

With healthcare fraud draining $760+ billion annually, pattern-matching detection methods are fighting a losing battle. Learn how investigative AI agents are revolutionizing fraud detection by reasoning like human experts instead of memorizing historical cases.

Published: August 20, 2025
Author: Yubin Park
Co-Founder / CTO

Manual fraud investigation across internal datasets, digital footprints, and public records takes weeks. Our AI agent orchestrates specialized sub-agents across all three data pillars, delivering comprehensive investigation reports in hours instead of days.

Published: August 11, 2025
Author: Yubin Park
Co-Founder / CTO

Despite impressive general intelligence, AI models struggle with specialized healthcare fraud detection. The gap isn't capability, it's context. Here's how Falcon AI bridges general intelligence to actionability by giving AI the right domain-specific tools, achieving 8.3/10 performance vs 6.5-7.2 for baseline models.

Published: August 6, 2025
Author: Yubin Park
Co-Founder / CTO

The Medicare Coverage Database governs $32 billion in improper payments yet finding relevant policies requires navigating 10,000+ documents with inconsistent medical terminology. Current search tools fail, forcing analysts to manually hunt through irrelevant results. Here's how Falcon Healthcare built AI that actually understands healthcare data.

Published: July 23, 2025
Author: Neil Ahuja
Founder / CEO

When "recession-proof" becomes free-fall, and billions vanish overnight

Published: July 7, 2025
Author: Yubin Park
Co-Founder / CTO

Stop being blindsided by utilization spikes and fraud schemes that traditional analytics miss. See how enhanced completion factor methodology with adaptive service grouping transforms reactive payers into proactive ones.

Published: July 2, 2025
Author: Yubin Park
Co-Founder / CTO

HHS-OIG revealed their keystroke error detection algorithm in 2023. We analyzed real client data and found 12.81% of I110 codes might be I10 typos, representing millions in audit exposure.

Published: July 1, 2025
Author: Yubin Park
Co-Founder / CTO

How we built custom domain-driven tools for our AI investigator to navigate Medicare coverage databases, turning fuzzy policy language into precise, searchable criteria that dramatically improve fraud detection accuracy.

Ready to put an AI co-analyst to work for your team? Let's talk.

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Blog - Insights from the Frontlines

Which MOR Is This? A Surprisingly Expensive Question

Understanding Medicare Overpayment Risk

Introducing Falcon MCP: Your LLM, Falcon's Data

Research Brief: Anomalous Urinary Catheter Billing and the ACO Exposure

How ACOs Should Approach FWA Campaigns: The Case for Structured Outreach

Who Is My Member? A Surprisingly Complex Question

Every Facility, Every Provider, One Search Away

From Co-Analyst to Autonomous Intelligence: Our Vision for Healthcare AI

Introducing Falcon Skills: Domain Expertise On Demand

Schedule Your AI Tasks: Automated Reports on Your Terms

Your Falcon Health Journey: A Step-by-Step Guide

Moving at the Speed of Thought: AI That Gives Teams Autonomy

Knowledge Without Bottlenecks: Transparency, Data Access, and Analytical Freedom

Set a thief to catch a thief

No Sales Calls, No RFPs, No Waiting: Healthcare Analytics That Respects Your Time

Beyond Pattern Matching: How FalconHealth's AI Agents Think Like Healthcare Fraud Investigators

Three Pillars of Data for FWA Research: How AI Agents Transform Healthcare Fraud Investigation

Bridging General Intelligence to Actionability: Making AI Actually Useful for Healthcare Fraud Investigation

Why Healthcare's Most Critical Database is Nearly Impossible to Search

The Health Insurance Crash of 2025: What's Behind the Selloff, And How to Fix It

Digging Up Signal from the Noise: How Real-Time Utilization Tracking Can Save Your MLR

The Million-Dollar Keystroke: How One Character Can Trigger an Audit

Equipping the Right Tools for Our AI Investigator Agent

Ready to put an AI co-analyst to work for your team? Let's talk.

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