MediBuddy unveils ‘Sherlock’ AI system to detect healthcare fraud & reduce costs

New Delhi: MediBuddy has launched an advanced AI-powered fraud detection system named ‘Sherlock’ to address fraudulent activities in healthcare reimbursement claims.

This innovative platform integrates artificial intelligence (AI), machine learning (ML), and data analytics to identify and prevent fraud in real-time, transforming how reimbursement processes are managed for healthcare providers, insurers, and patients.

Healthcare fraud leads to financial losses, harms reputations, and invites regulatory scrutiny. MediBuddy’s strategy to tackle this issue combines its expansive cashless network with Sherlock’s robust fraud detection capabilities. MediBuddy’s approach aims to reduce costs by up to 20% by eliminating the need for traditional reimbursement processes, with savings split evenly between the cashless network (10%) and Sherlock’s fraud detection features (10%).

Satish Kannan, Co-founder and CEO of MediBuddy, highlighted the system’s impact, stating, “Fraud in healthcare reimbursement claims undermines the integrity of the entire system. By integrating this AI-driven solution, we’re empowering our partners and users to safeguard against fraudulent activities while ensuring an efficient and seamless claims process for patients. We, at MediBuddy, believe in a preventive and data-driven approach to healthcare and have built innovative solutions that help combat Fraud Waste and Abuse. Our methodology helps identify risks before they become problems. This enhances trust, develops a fair system, saves costs and safeguards reputation.”

He added, “Our collaboration with one of our most valued partners has yielded remarkable outcomes. Our strategic integration of an extensive cashless network with advanced AI technology has yielded substantial results: a remarkable ₹6.3 crore cost reduction for our partners within a single policy year. Leveraging a decade of industry expertise and proprietary technology, we have established a comprehensive network encompassing over 1,00,000 healthcare providers. We’re making premium care accessible to millions while slashing corporate healthcare expenses.”

Sherlock leverages the latest AI and machine learning technology to provide real-time analysis and alerts of claims, spotting potential errors or fraudulent activities before they escalate.  The system’s advanced features include continuous learning and adaptation to detect new types of fraud, instantaneous claim analysis with automated alerts for suspicious activities, and pattern recognition to spot common fraudulent behaviors like inflated amounts or duplicates. 

Additionally, Sherlock monitors user behavior to detect anomalies, further enhancing its fraud detection capabilities. This flexibility allows it to cater to the specific needs of different corporations and insurers, detecting issues like claim duplication, document tampering, pricing discrepancies, and compliance lapses without the need for constant manual oversight.

MediBuddy’s new system represents a major advancement in healthcare fraud prevention, offering a more secure and efficient reimbursement process.