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Fraud, Waste & Abuse Detection

Uncover Healthcare Fraud, Waste and Abuse With Speed and Accuracy

Detect and prevent provider and member fraud, illuminating poor behaviors such as upcoding, ghost sessions, unnecessary treatments, provider collusion and much more

Download the Data Sheet  

£10B+

Value of Health Claims Analysed

50M+

Lives Covered Across Shift Customers

£1B+

Healthcare Fraud, Waste & Abuse Detected

200+

Insurance Focused Data Scientists

£10B+

Value of Health Claims Analysed

50M+

Lives Covered Across Shift Customers

£1B+

Healthcare Fraud, Waste & Abuse Detected

200+

Insurance Focused Data Scientists

Fraud, waste and abuse is hard to detect amongst large volume, low value claims. It's hard to justify investigation and even harder to prioritise where to focus limited resources.

Shift’s healthcare-trained AI models unearth suspicious patterns in both provider and member activity, cross checking historic data, invoices, documents and any relevant third party data.

Boost investigative efficiency by 200%
Boost investigative efficiency by 200% Increase detection accuracy by 3x Uncover 4x higher value FWA Seamless investigative workflows
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Boost investigative efficiency by 200%
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Increase detection accuracy by 3x
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Uncover 4x higher value FWA
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Seamless investigative workflows
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Investigators are here to investigate, not spend time combing through sources for the right data or information. With enhanced provider and member data, combined with extensive external data, Shift gets the right insights to investigators faster.

Investigative detail all in one place

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Skip hours spent compiling data and information with claim and provider details, online reviews, exclusion lists and much more already integrated into the platform.

Uncover related providers

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Alerts with context and action

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Any data, any format

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Powerful detection across the health insurance lifecycle

Claims Operations
Claims Operations CIOs and IT Chief Medical Officers Investigation Team Leaders
Claims Operations
CIOs and IT
Chief Medical Officers
Investigation Team Leaders
“The best data available suggest that across all healthcare systems, fraud accounts for between 3.29% and 10% of all health care expenditure, with an average of around 5.59%. In the NHS this would translate to £3.35 billion a year lost to patient care."
Mark Button and Colin Leys, CHPI
Shift's healthcare-trained AI models can illuminate patterns in both low and high value fraud waste and abuse in providers, networks and members increasing FWA savings by as much as 4x.

Customer Success Stories

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42M€ saved in 2022 alone

"It's a cat and the mouse game. Fraud evolves very quickly and can take very different forms to which insurers must adapt and, above all, to show that they act.”
Head of Control and Investigations Department
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Top 4 use cases to streamline healthcare

"Learn how we empower the world's leading health insurers to make faster more accurate decisions."
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Learn how Shift can help you successfully identify, investigate and prevent more fraud

 

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