WhiteHatAI: AI that Fights Healthcare Fraud, Waste, and Abuse

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Peter Ransome, President & CEO
“If fraud, waste, and abuse (FWA) in the U.S. healthcare industry were an economy, it would be the 19th largest economy in the world,” states Peter Ransome, CEO and president of WhiteHatAI. Healthcare fraud not only disrupts a healthcare system’s cash flow but also causes severe monetary liabilities for insurance providers, employers, and patients. Currently, FWA in healthcare claims in the U.S. is estimated to be in excess of $650 billion per year. What makes this cost so damaging to society, other than the sheer magnitude, is that employers, patients, and taxpayers pay the price. US citizens simply are not getting the healthcare that they are paying for. “This problem is nothing new and is continuing to increase for a variety of reasons; we believe the industry needs a complimentary, advanced AI solution like ours in order to fight back on this complex payment integrity disaster,” says Ransome.

To counter the continually evolving set of FWA problems, WhiteHatAI offers CENTAUR—a cognitive deep learning artificial intelligence (AI) platform—to commercial insurance firms, healthcare auditing companies, and Medicare-Medicaid agencies. The CENTAUR learns directly from the healthcare professionals who interface with the system, creating a deep, continual learning environment. The platform is deployed via cloud or on-prem and “it reviews and audits healthcare claims data for over 1000+ different problems,” explains Ransome. CENTAUR delivers its findings to medically trained experts who then have clarity through system provided information to make critical payment decisions, which result in the approval, denial, or further investigation of a claim submitted for payment.

“Healthcare insurers can position WhiteHatAI’s cognitive AI platform anywhere in their workflow. The optimum position in the payment process is prior to making payments, either before, during, or post-adjudication,” states Ransome. “We have also built a series of AI models within CENTAUR to detect suspicious schedule II narcotic (opioid epidemic) activities across the healthcare continuum.” The platform increasingly eliminates the need for manual review by medical claims examiners in order to detect low integrity claim payments. With an easy installation process and short 2 to 4 week training period, the CENTAUR is available to complement existing claims adjudication system with advanced pre-payment scalable auditing and review.


Our deep learning AI implements its acquired knowledge and, over time, becomes increasingly independent of its human counterparts in analyzing and detecting suspicious and fraudulent claims


“Our deep learning AI constantly learns, and over time, becomes increasingly independent of its human counterparts in analyzing and detecting suspicious and fraudulent claims,” says Ransome.

The CENTAUR is always working, always learning, and always improving. Using a unique combination of ML, NLP, analytics, and cognitive AI, WhiteHatAI has been able to improve the integrity of healthcare claims payments. When one client implemented the platform, WhiteHatAI immediately found 8 percent of the claims analyzed to be fraudulent. Moreover, CENTAUR can audit at incredible speeds of 40,000+ claims per hour in the base configuration.

WhiteHatAI has designed the architecture to scale up with computing horsepower and run in any environment. CENTAUR audits claims inline and real-time, preventing erroneous payments from being made and thereby reducing the cost of healthcare for all.

With a highly experienced team of healthcare veterans, data scientist, and AI experts, WhiteHatAI sees 2019 to be a year of significant growth and expansion. “We are also excited about our new collective IQ platform that will change the way the industry works together to address this severe ongoing payment integrity issue,” says Ransome. The company’s goal is to drive collaboration between users to further improve WhiteHatAI’s cognitive and deep learning AI and create a community that, as a team, comes together to fight FWA in healthcare transactions across the U.S. and beyond.

WhiteHatAI News

WhiteHatAI Announces Artificial Intelligence Driven Healthcare Payment Integrity Platform

RALEIGH, N.C.: An innovative healthcare AI software company, WhiteHatAI (www.whitehatai.com), announced the release of the Centaur Software platform for detecting Fraud, Waste, and Abuse in healthcare transactions.

Peter Ransome, CEO/President, stated, "Artificial Intelligence has allowed for incredible innovation across the healthcare landscape and our team of industry veterans are at the forefront of that innovation. The Centaur platform places advanced artificial intelligence in the hands of the healthcare industry in an easy to deploy, cost-effective package. Most impressively, the Centaur learns and becomes 'smarter' over time as the system interacts with data and users. The WhiteHatAI Centaur provides payers, providers, employers, and auditing firms with a platform that rapidly and accurately detects claim FWA problems pre-payment or post."

Ransome went on to say, "As we are launching the WhiteHatAI Centaur for claims pre-payment auditing, WhiteHatAI is also releasing a powerful version of the Centaur for detecting Opioid Fraud, Waste, and Abuse. We chose to accelerate the release of the opioid system due to the seriousness of the crisis and are busy building our ecosystem of complementary partners."

Fraudulent and inaccurate healthcare claims cost insurance payers $650+ billion annually. Prompt payment regulations have historically prevented the payer's ability to fully review claims for fraud, waste and abuse prior to payment. This situation produces a post-payment "pay and chase" collection scenario where payers are forced to recover incorrect payments. 90+% of these incorrect payments are never recovered. The healthcare industry carries this tremendous cost burden, ultimately impacting all Americans and our accessibility to healthcare and our quality of care.

The WhiteHatAI Centaur software platform is a true game changer. With an advanced AI fraud-detection system, healthcare payers can now examine every claim and claim line item pre-payment. Pre-payment auditing places WhiteHatAI's clients in a position to reduce and eliminate costly and problematic "pay and chase" scenarios.

WhiteHatAI Centaur is a deep learning, unique multi layered AI forensic tool built to complement existing systems and workflows that can be deployed either on-site or via the cloud.

Company
WhiteHatAI

Headquarters
Raleigh, NC

Management
Peter Ransome, President & CEO

Description
Offers a cognitive and deep learning artificial intelligence (AI) platform to commercial insurance firms, healthcare auditing companies, and Medicare-Medicaid agencies

WhiteHatAI