Blog - Insights from the Frontlines

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

Set a thief to catch a thief

Published
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.

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

Published
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.

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Equipping the Right Tools for Our AI Investigator Agent

Published
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.

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