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Healthcare Fraud Shield

Chesterfield, Missouri, United States

Ownership: Private
Employees: ~75
Development stage: Commercial

Overview

Healthcare Fraud Shield provides an integrated SaaS platform using artificial intelligence, proprietary data fusion, and expert rules to detect and prevent healthcare fraud, waste, abuse, and error. Their solutions deliver measurable ROI by reducing false positives in claim reviews by up to 98%, improving efficiency of special investigation units (SIUs), and supporting both pre-payment and post-payment workflows. The platform is trusted across Medicaid, Medicare, commercial plans, pharmacy benefit managers (PBMs), and other payer organizations.

Industry: Biomedical IT and Biomedical Data Platforms

Partnerships

NHCAA (National Health Care Anti-Fraud Association)ACAP (Association for Community Affiliated Plans)AAPC local chapters

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