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Cloud Applications & Integration

Detect Fraud with AI

Project Overview
Project Overview

Our Fortune 100 healthcare client was struggling to detect and quantify the damages caused by fraudulent provider activities.

Concord Europe engaged to identify providers that are part of the network and are directly or indirectly involve in fraud.

Results area

By working with Concord Europe’s AI Cloud platform, our client developed an analytics application that analyzed internal and external data to flag and evaluate malicious activities by in-network providers.

The approach collected external, publicly available unstructured data augmented with governmental and internal enterprise data to apply an array of NLP, ML, and deterministic approaches in a continuous manner.

After a month of operating under the newly created system, our client:

  • Identified 612 questionable providers potentially involved in fraudulent activities
  • Saved $2.3B USD in damages against the national and private insurance funds
  • Cleaned up 500+ malicious providers from the network
  • Improved providers’ data reliability by 250%

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