MediBuddy, India’s largest digital healthcare platform, announced the launch of its groundbreaking AI-powered fraud detection system for healthcare reimbursement claims. This cutting-edge platform harnesses the power of advanced technologies such as artificial intelligence (AI), machine learning (ML), and data analytics to detect and prevent fraudulent claims in real-time, revolutionising the reimbursement process for healthcare providers, insurers, and patients.
Organisational fraud goes beyond finances, damaging reputation and inviting regulatory scrutiny. One way to stop Fraud, Waste and Abuse (FWA) is by stopping the reimbursement process and enabling cashless solutions. MediBuddy’s approach, which combines a vast cashless network with Sherlock’s advanced FWA detection capabilities, has the potential to cut costs by up to 20%. This substantial saving is achieved through a 10% reduction via the cashless network and an additional 10% through Sherlock’s FWA detection. By eliminating the reimbursement process, cashless solutions significantly reduce opportunities for fraud.
Satish Kannan, Co-founder and CEO, MediBuddy said, “Fraud in healthcare reimbursement claims undermines the integrity of the entire system. By integrating this AI-driven solution, we’re empowering our partners and users to safeguard against fraudulent activities while ensuring an efficient and seamless claims process for patients. We, at MediBuddy, believe in a preventive and data-driven approach to healthcare and have built innovative solutions that help combat Fraud Waste and Abuse. Our methodology helps identify risks before they become problems. This enhances trust, develops a fair system, saves costs and safeguards reputation. Our collaboration with one of our most valued partners has yielded remarkable outcomes. Our strategic integration of an extensive cashless network with advanced AI technology has yielded substantial results: a remarkable ₹6.3 crore cost reduction for our partners within a single policy year. Leveraging a decade of industry expertise and proprietary technology, we have established a comprehensive network encompassing over 1,00,000 healthcare providers. We’re making premium care accessible to millions while slashing corporate healthcare expenses.”
Sherlock leverages cutting-edge AI and machine learning algorithms to provide real-time analysis and alerts, identifying potential errors or fraud before they occur. The system is highly adaptable, allowing customization to meet the unique needs of different corporations and insurers. Sherlock automatically detects issues such as claim duplication, document tampering, pricing discrepancies, and compliance lapses, eliminating the need for constant manual review and saving both time and money.
Key features of MediBuddy’s fraud detection system include:
- Advanced AI and ML Algorithms: Continuously learning and adapting to detect new fraud types for unparalleled accuracy.
- Real-time Analysis and Alerts: Instantaneous claim analysis upon submission, triggering automated alerts for suspicious activities.
- Pattern Recognition: Identifies patterns common in fraudulent claims like inflated amounts, duplicates, or discrepancies.
- User Behavior Monitoring: Tracks user behavior patterns to detect anomalies indicating potential fraud.
MediBuddy’s fraud detection system represents a paradigm shift in the healthcare industry, fostering a more secure, efficient, and patient-centric reimbursement process. By leveraging the power of AI and data-driven insights, MediBuddy is paving the way for a future where healthcare providers, insurers, and patients can focus on what truly matters – delivering and receiving high-quality care.
