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Fraud, Waste, & Abuse

Deliver excellent patient outcomes and change poor claim and billing behaviour with AI

Quickly detect medical inconsistencies, hidden pre-existing conditions, ghost sessions and other potential FWA and errors across providers, members and networks

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

Uncover Healthcare Fraud, Waste, Abuse and errors with AI-powered speed and accuracy

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

Prioritise patient care and prevent FWA
Prioritise patient care and prevent FWA Uncover 4x higher value FWA AI accelerated efficiency Future proof operations with AI
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Prioritise patient care and prevent FWA
 files-lightBG_Target
Uncover 4x higher value FWA
 files-lightBG_Funding USD
AI accelerated efficiency
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Future proof operations with AI
files-lightBG_Improved Efficiency

Leveraging AI to automate analysis of all claims, treatments, invoices and documents ensures any potential medical risks are investigated quickly allowing you to deliver prompt claim management and care

Ensure medical consistency

Leverage the Shift bank of AI scenarios centered around medical consistency such as correct drug dosages, treatment applicability and condition checks.

AI-powered outlier analysis

Configurable rules

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.

Shift Technology Named a Celent Luminary in 2024 Insurance Fraud Detection Solutions Reports for Both Property & Casualty and Health

Shift Technology, a provider of AI-powered decision optimization solutions for the global insurance industry, today announced that Shift Claims Fraud Detection and Shift Improper Payment Detection/Fraud, Waste and Abuse Detection achieved Luminary status in Celent’s recently published Insurance Fraud-Detection Solutions: Property and Casualty Insurance, 2024 Edition and Insurance Fraud-Detection Solutions: Health Insurance, 2024 Edition respectively

Customer Success Stories

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56M € saved in 2024 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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