ToolCASE AI Solutions Fight against fraud in healthcare: integrate AI into your ERP planning and implementation


Integrate AI into your ERP planning and implementation

The world’s most advanced transactional AI company. Preferred choice for customizable real-time AI solutions

GREENWOOD VILLAGE, COLORADO, USA, October 27, 2021 / – During this pandemic, businesses, like so many others in their personal lives, have faced unexpected and unusual challenges. Not just because of the virus. but also because of the economic upheavals and the resulting uncertainty. Unfortunately, fraud in the healthcare system has become a major concern of criminals.

Health fraud has skyrocketed. This has accelerated the trend of companies to improve their ERP (Enterprise Resource Planning) and their implementation. ERP applications may offer software as a service (SaaS). A complete suite of ERP applications forms an ERP system capable of effectively communicating and aggregating business processes. This enables data flow between applications and databases on premises or through cloud solutions. ERP implementation has been crucial because so many people are working from home.

A deep development in the sprint to modernize ERP is the adoption of artificial intelligence for use in the detection of fraud in healthcare, as well as banking operations, anomalies in commercial contracts and shopping (and much more). AI enables real-time data collection, analysis and forecasting.

Why is real-time risk analysis important for detecting healthcare fraud?

AI-driven real-time risk analysis and management enables compliance and enforcement teams to identify fraud in real time and act on it before it’s too late.

According to the American Coalition Against Insurance Fraud, “Tens of billions of dollars are stolen each year by fraudulent means in the health care field. »1 Healthcare fraud. 2 As a result of the pandemic, the costs of healthcare fraud are rising rapidly for insurance companies.

A major area of ​​healthcare fraud is overcoding or overcharging already expensive hospital stays for COVID-19, along with a plethora of other scams and cybercrime, such as:

• Pharmaceutical fraud – excluding AMM, bribes, adulterated products
• Medicaid reimbursement fraud
• Over-prescription or unnecessary prescription
• Falsified diagnostics
• Ambulance fraud
• Unreasonable costs of drugs and services
• Invoicing of services not rendered or services not offered
• Home health fraud

The Most Advanced AI Against Healthcare Fraud

Real-time risk management enables healthcare providers to identify fraud as it occurs, to avoid making payments on fraudulent activities. So, to protect their business, having the optimal AI software is essential. There is a need to integrate AI into all ERP planning and implementation.

The world’s most advanced transactional AI software is created by ToolCASE. ToolCASE offers a suite of products serving health insurance organizations, hospitals and medical practices, as well as banking, financial and credit institutions. All bear the brunt of healthcare fraud.

The solution to healthcare fraud lies in ToolCASE’s proprietary RembrandtAi and Informant functionality, its real-time analysis capability, data aggregation from multiple sources, and data presentation through visualization and alerts.

Implementing the ToolCASE AI suite can happen in days or weeks, not years. Installation and employee training is quick, transparent and intuitive. Businesses using the ToolCASE software suite with Rembrandt AI and Informant can anticipate and resolve customer queries, expedite pre-approvals, review complaints, manage memberships and invoicing, improve quality, and maintain regulatory compliance through automated reporting and regulatory updates. ToolCASE does it all. And keep your compliance or fraud department running with exceptional efficiency.

Additional benefits include risk management and compliance for financial institutions such as insurance companies. This includes internal audit and cybersecurity capabilities. Analysis of transaction, balance and intent trends and patterns are presented in data visualization and alert formats. RembrandtAi integrates with online and mobile banking and other self-service systems for automatic registration and alerting to consumers.

The optimal AI-based breakthrough is finally here for health insurance organizations. With the implementation of the ToolCASE suite of AI products in ERP, organizations have effective “war room” defense at their fingertips.

Sam piccolotti
+1 888-400-8114
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