AI Solutions for Healthcare


Our customers drive savings across payment integrity, SIU, network and clinical teams

We help some of the largest plans and agencies in the country identify opportunities to control costs. Below are examples of a few of our customers.

State Medicaid Agency

2.5+ million members

AI helped Program Integrity Unit at State Medicaid Agency realize a 1,500% ROI



4+ million members

Highmark identifies millions in new active cases with AI-powered provider analysis from Codoxo


midwest plan

2.5+ million members

Ensures fraud and payment integrity teams are using AI to protect the plan

3+ million members

Harvard Pilgrim Health Care embraces artificial intelligence from Codoxo to detect FWA issues


southeast plan

3+ million members

Large plan protects public health funds by proactively identifying ways to control healthcare costs with Codoxo

Pacific Health Plan

700+ thousand members

Several departments at this plan use our AI solutions to meet their needs

State Medicaid Agency

2 million recipients

State agency modernizes Medicaid fraud detection with advanced A.I.

1 billion

Claims processed
by AI


Identified savings
by Codoxo


Reduction in false positives


Increase in productivity

"Codoxo's Forensic AI Platform is a game changer.
AI is helping us identify, prevent, and stop potentially fraudulent activities earlier than ever.”

– Kurt Spear, Vice President Financial Investigations and Provider Review

Saving millions at world-class insurance companies and healthcare agencies including:

State Medicaid Agency

2+ million recipients

Southeast Plan

3+ million members

Midwest Plan

2.9 million members

Pacific Health Plan

700K+ members


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

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.

Fraudscope is now Codoxo. LEARN MORE >