MediBuddy, a digital healthcare platform in India, has introduced ‘Sherlock,’ an AI-powered system designed to detect and prevent fraud in healthcare reimbursement claims. The platform uses artificial intelligence (AI), machine learning (ML), and data analytics to identify fraudulent claims in real-time, aiming to streamline the reimbursement process for providers, insurers, and patients.
Fraud in healthcare reimbursement can damage reputations and invite regulatory scrutiny. MediBuddy’s solution integrates a large cashless network with Sherlock’s fraud detection capabilities, potentially reducing costs by up to 20 percent. This includes a 10 percent savings from the cashless network and another 10 percent from Sherlock’s Fraud, Waste and Abuse (FWA) detection. By eliminating the reimbursement process, MediBuddy reduces 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,” he added.
Sherlock uses AI and ML algorithms for real-time claim analysis and alerts, identifying potential errors or fraud before they occur. The system can be customised to fit different needs and automatically detects issues such as claim duplication, document tampering, pricing discrepancies, and compliance lapses.
Key features of Sherlock include its use of AI and ML algorithms to achieve accurate fraud detection, real-time analysis and alerts for suspicious claims, pattern recognition to identify common fraud indicators, and the monitoring of user behaviour to spot anomalies. These features collectively enhance the system’s ability to prevent and manage fraudulent claims efficiently.
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, informed the statement.