Fraud, Waste, & Abuse

Maximize Recoveries with Proprietary AI Solutions for Healthcare Fraud, Waste, and Abuse Detection.

Codoxo’s AI-powered solutions help SIU teams detect and prevent fraud, waste, and abuse (FWA) with unmatched speed and accuracy.

Fraud waste and abuse expert using AI fraud detection tools on her laptop to address healthcare fraud

Using proprietary AI fraud detection to analyze claims in real time, Codoxo’s solutions quickly identify outlier claims and providers, uncover hidden patterns, and enable early intervention for cost savings and maximum recoveries.

Ready to Achieve 3X ROI with Codoxo’s FWA Solutions?

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Threats to Your Bottom Line Move Quickly – That’s Why We Help You Move Faster.

Codoxo’s fraud, waste, and abuse solutions equip healthcare payers to effectively identify providers with outlier behaviors – indicative of potential healthcare fraud, waste, and abuse.

This proprietary AI uncovers anomalies and patterns often overlooked by traditional methods, enabling faster, more accurate, and comprehensive detection.

Additionally, to accelerate data exploration, our solution includes a generative AI-powered natural language query tool with a built in user-friendly interface for intuitive querying and clear scheme explanations.

SIU teams can efficiently manage investigations, oversee cases from beginning to end and leverage detailed regulatory and departmental reporting, to strengthen program integrity.

Colleagues reviewing Medicare fraud, Medicaid fraud, prescription fraud, and dental fraud on a tablet

KEY BENEFITS

Your Bottom Line Depends on It—Let Us Help:

Stay ahead of evolving threats

Leverage fast, accurate detection of outlier claims and providers to proactively counter sophisticated schemes

Uncover more leads with precision

Pinpoint potential fraud, waste, and abuse with greater accuracy for better investigative outcomes

Reduce
unnecessary costs

Target wasteful or abusive practices at the source to safeguard your resources

Prioritize
high-risk cases

Focus your SIU on the most critical leads, guided by AI-powered insights that streamline investigative workflows

Simplify
data exploration

Act faster and conduct deeper, more impactful investigations through an intuitive interface that simplifies complex fraud schemes

Accelerate investigations with generative AI

Rapidly create and refine queries using natural language, uncovering hidden anomalies and reducing time to insight

Maximize recoveries

Identify improper payments early and boost ROI with swift, effective recovery efforts

Streamline SIU operations

Leverage pre-built compliance reports to save time and enhance efficiency

HOW IT WORKS

Capture Fraud, Waste, & Abuse That Others Miss

Codoxo’s FWA solutions combine a market-leading FWA platform, driven by advanced AI, with generative AI-powered query capabilities that empower healthcare payers with a powerful advantage in detecting and preventing fraud, waste, and abuse.

Our solution analyzes massive volumes of claims data, including professional, facility, pharmaceutical, behavioral, and dental claims and identifies issues and opportunities that may arise from complex claims and codes, in addition to the standard ones which helps discover a wider range of existing and emerging problems.

Codoxo’s FWA solution detects anomalies and patterns across the data and proactively flags high-risk behaviors, guiding your SIU toward the most impactful cases, improving both cost savings and recovery outcomes.

Unlike any other fraud, waste, and abuse solution on the market, our FWA platform includes built-in natural language query functionality to augment automated detections for rapid identification of outlier behavior. Instead of traditional complex coding or lengthy manual searches, SIU investigators and analysts can type questions in natural language — immediately drilling down into precise data sets and surfacing new leads. This streamlined approach accelerates investigations by eliminating tedious steps, enabling your team to focus on strategic tasks that drive value. The result is faster lead and insight generation, quicker case resolutions, and the confidence that your organization is always one step ahead of evolving fraud schemes.

With Codoxo’s FWA platform and query capability working together, SIUs gain a comprehensive toolset that not only protects financial resources but also fortifies compliance and elevates the performance of the entire SIU function.

OUTCOMES

Codoxo’s AI-Driven FWA That Deliver Results

97%

of all fraud, waste, and abuse errors captured

100’s

of customers achieved significant reduction in false positives

$30 million

exposure identified for a pharmacy benefit manager (PBM)

$25 million

in outlier behavior uncovered in a pharmacy/prescriber scheme

$6+ million

paid exposure identified in a single pharmacy case

Explore Codoxo’s Full Solutions Offerings

Smarter Healthcare Cost Containment Starts With Codoxo

Codoxo’s solutions are delivered through our Unified Cost Containment Platform, empowering healthcare organizations to take a seismic shift left by ensuring faster, more accurate claim payments, reduced fraud, waste, and abuse, and enhanced operational efficiency. By transforming the landscape of healthcare cost containment and payment integrity with industry-leading AI, Codoxo is at the forefront of making healthcare more affordable and effective.