Deep dives into healthcare fraud detection, AI innovation, and program integrity insights from our team.
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.
Read moreManual 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.
Read moreDespite 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.
Read moreThe 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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When "recession-proof" becomes free-fall, and billions vanish overnight
Read moreStop 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.
Read moreHHS-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.
Read moreHow 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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