Unmatched Fraud, Waste, Abuse & Error Detection
Leverage the most advanced claims data analysis to quickly identify and prevent suspicious healthcare claims, enabling you to save time and maximize savings with confidence.
We’re Changing the Healthcare Payment Integrity Game
Our proprietary data fusion library integrates internal and external sources like NPI, SOS data, state sanctions, virtual offices, and a shared analytics database. We continuously update and expand our 2,000+ industry alerts, use AI-driven anomaly detection, and provide claim-line level insights.
Proven Results with the HCFSPlatform®
Improved ROI
When paired with our SIU/PI services, the HCFSPlatform delivers an ROI of up to
20:1
Increased Efficiency
Using our HCFSPlatform and SIU/PI services reduces lead generation time by
2/3
Enhanced Compliance
HCFSPlatform ensures more accurate FWAE detection by reducing false positives by
98%
Built by Experts, Backed by Experience
At Healthcare Fraud Shield, our platform is built by seasoned experts, including former SIU investigators, auditors, clinicians, coders, and analysts with deep, real-world experience in healthcare fraud prevention. Our SMEs help shape our solutions to reflect the daily challenges payers face. Their insights drive smarter detection logic, streamlined workflows, and alignment with regulatory demands.
What This Means for You
Immediate Value
with tools and logic designed by people who have done the work
Relevant Support & Training
from experts who understand your challenges and speak your language
Smarter Detection Models
based on real-world FAWE tactics and evolving schemes
Better Outcomes
through continuous collaboration and knowledge sharing
With Healthcare Fraud Shield, you get more than software. You get trusted expertise working alongside you to protect every healthcare dollar.
Post-Pay Analytics
Ad-Hoc Reporting
SVRS & Medical Record Retrieval
Pharmacy Analysis
Auto Lead Generation
Expert SIU/PI Services
Pre-Pay Analytics
Case Management
Artificial Intelligence
Client Consortium
Diagnosis Validation
Our committed customer support doesn’t stop at the sales desk.
Need assistance with any of your HCFS products?
Enhance Your HCFSPlatform with Expert SIU/PI Services
With 13 years of exclusive focus on FWAE, PI, SIU and compliance in the healthcare payer market, integrating our SIU services with the HCFSPlatform boosts your fraud detection and payment integrity efforts.
