Healthcare Fraud Shield

Website: www.hcfraudshield.com

Healthcare Fraud Shield (HCFS) is a leading provider of fraud, waste, abuse, and error (FWAE) detection and payment integrity solutions for healthcare payers nationwide. Our platform stops improper claims before payment and detects issues after payment using advanced analytics, AI, and shared intelligence from a broad client network.  With over 14 years of exclusive focus on FWAE and payment integrity, HCFS was built by industry experts to deliver measurable results. Clients typically achieve an average up to 10:1, and higher when leveraging HCFS Services.

Why HCFS:

• Enterprise-wide SaaS solution – Used by health plan teams across SIU/FWA, Payment Integrity, Risk, UM, Claims, Legal, Operations, and Finance
• 2,100+ FWAE rules – The largest FWAE rule library in the industry
• AI + Human-in-the-Loop – 11 AI models (FWA360Leads, AIShield, RecordPlus), all expert-validated
• Shared Analytics – Insights from 95M+ members across plans to uncover new, high-value cases beyond internal data
• 85+ external data sources – Enrich claims data for more precise detection
• Trusted by 70+ clients, including 7 of the 10 top commercial payers and 3 of the 5 of the top national payers