AI Solutions for Healthcare

FraudScope AI Platform Delivers Results for Highmark Inc. Financial Investigations and Provider Review Department


FraudScope AI Platform Delivers Results for Highmark Inc. Financial Investigations and Provider Review Department
FraudScope’s AI Technology Is Helping to Change the Paradigm of How Fraud, Waste and Abuse is Identified in Healthcare

ATLANTA (February 18, 2020) – FraudScope, an AI-based platform that helps health plan special investigations units, payment integrity, and medical review teams investigate fraud, waste, and abuse (FWA), today revealed its platform has helped Highmark’s Financial Investigations and Provider Review department identify potential FWA schemes more quickly than traditional analytics, in turn helping them achieve millions of dollars in savings.

FraudScope began working with Highmark in 2019 with Kurt Spear, Vice President of Financial Investigations and Provider Review, as a part of Highmark’s larger payment integrity strategy to drive down fraud, waste, and abuse. As referenced in a February 3, 2020 news announcement from Highmark, the Financial Investigations and Provider Review department has experienced more than $260 million in savings related to fraud, waste, and abuse in 2019 alone, with the escalation in savings attributed, in part, to the newly implemented AI initiative with FraudScope.

“FraudScope’s patented AI technology helps our health plan customers achieve significantly better results and at a faster pace than traditional rules-based fraud detection products. Implementations typically only take weeks which enable customers to be live and experiencing results very quickly,” stated Musheer Ahmed, CEO of FraudScope. “We are thrilled for the Highmark team and their astronomical fraud detection results and are pleased to have FraudScope play a role in their sophisticated payment integrity efforts.”

According to Highmark’s Spear, “AI is a game-changer for everyone,” and their February 3 news release describes how they are seeing positive results from their use of FraudScope’s AI capabilities which, combined with their established technologies and mature, experienced manual assessment process, has led to their industry leading effort.

FraudScope’s AI platform was live with Highmark in less than three months and, according to the team, they are identifying suspect billing and coding scenarios that have the potential of realizing a significant return on their investment with FraudScope. According to Latrisha Oswald, Director of Highmark Financial Investigations and Provider Review, “FraudScope and their team assisted with every step of the implementation process and continue to be a collaborative partner to consistently enhance and tailor the platform to our needs in order to identify potential FWA as close to real-time as possible.”

More information about FraudScope and its capabilities can be found at

About FraudScope
FraudScope is an AI-assisted platform that accelerates the identification of fraud, waste, and abuse. Our comprehensive claims investigation platform utilizes proven and patented AI-based technology to empower investigators and analysts to derive insights and conduct full investigations of suspect claims. For additional information about FraudScope and our solutions, visit

For More Information Contact:
David Grice
(678) 296-8918