AI Solutions for Healthcare

Passion is at the heart of Codoxo’s mission to improve U.S. healthcare affordability. It’s what fuels the innovation in our cutting-edge artificial intelligence (AI) to help deliver cost containment to our clients and significantly reduce the impact of fraud, waste, and abuse (FWA). We are proud to share that our passion, determination, and drive has been recognized – Codoxo has won the 2022 Fierce Healthcare Innovation Award in the Data Analytics/Business Intelligence category.

The Data Analytics/Business Intelligence category recognizes “solutions that bring actionable information directly to users by either enabling the wide dissemination of clinical, financial or operational data, or helping them make sense of it.”

“Codoxo represents my drive for innovation and deep academic rigor – this technology was first developed as part of my Ph.D. dissertation at Georgia Institute of Technology,” said Dr. Musheer Ahmed, Chief Executive Officer and founder of Codoxo. “And the Codoxo team is tirelessly dedicated to advancing what our AI can do for our customers. We are proud to be able to collaborate closely with our clients daily to create a long-lasting impact on cost containment and we are grateful to be nominated for the award by Fierce.

Solving costly fraud with a single healthcare AI platform

In 2021 alone, the Department of Justice recovered more than $5.6 billion from civil fraud and false claims cases, just a fraction of the estimated $380 billion lost every year to fraud, waste, and abuse (FWA). These numbers add up to higher premiums and out-of-pocket expenses for consumers, as well as reduced benefits or coverage.

With millions of claims coming into healthcare companies, payers, and agencies, it’s hard to distinguish between appropriate care, a simple coding mistake, and intentional fraud. To further compound the issue, healthcare companies are often operating with data, department and system silos, and are solely using rules-based FWA tools that cannot keep up with quickly evolving schemes and bad actors. Codoxo’s self-learning AI gives these healthcare companies, payers, and agencies a unified way to detect current and evolving problems and take action proactively to control costs – before they add up to a big hit on the bottom line and billions of dollars lost to fraud, waste, and abuse in the U.S. healthcare ecosystem.

The Fierce Innovation Report indicated that “typical AI and rules-based techniques miss opportunities to find fraud, waste, and abuse (FWA) because a human has to identify the scheme, and then train the AI to detect it going forward. Codoxo’s platform breaks from this tradition—avoiding substantial financial loss. Plus, Codoxo’s technology uniquely blankets the payment system into one integrated platform.”

What makes us “Fierce”

The full report shares how Codoxo’s AI platform is “Fierce”, including ways in which it is helping clients identify savings, reducing false positives in fraud detection, delivering ROI and more.

Just five years after launching its business, Codoxo is delivering upon its brand promise. We’re leading the industry in developing a unified, single platform that can be used across all cost containment departments. We’re re-envisioning how healthcare payers and agencies can collaborate across their organizations, all on the same claims data.

“Up until now, the healthcare system has been siloed, even within one organization there are multiple teams that work on the problem and have individual special investigation units to identify payment fraud and waste abuse,” Dr. Musheer Ahmed, Codoxo’s Chief Executive Officer and Founder says.

Codoxo is joined by Vital Data Technology, PointClickCare, and Rhino Health in the 2022 Fierce Healthcare Innovation Award finalist shortlist. Codoxo also was a 2021 Fierce Healthcare Innovation Award finalist.

To access the full Innovation Report, visit us here.


Our Forensic AI Engine analyzes your data, detects problems, and builds connections across your data to provide actionable insights

Insight Scope

For everyone across the health plan

Clinical Scope

For clinical teams

Audit Scope

For everyone across the health plan and PBM

Network Scope

For network teams

Payment Scope

For payment integrity teams

Provider Scope

For network and payment teams

Fraud Scope

For SIU teams


We provide a full range of professional services, from data migration and ongoing customer success through flexible virtual SIU options.