Fraud, waste, and abuse

Recover millions with 
AI-powered fraud, waste, and abuse (FWA) engine

FWA in healthcare costs organizations millions every year. Healthee’s AI engine and recoupment team puts that money back in your hands

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Stop paying for fraud, waste, and abuse

Healthee’s AI-powered fraud, waste, and abuse system has already identified $10.6M in suspicious claims for a single self-insured employer in 2025 alone. We have also identified $2.9 million in suspicious claims for another self-insured employer, representing 10.2% of their total plan spend in 2024.

Healthee’s proprietary AI-powered FWA detection engine surfaces suspicious patterns invisible to traditional audits, driving millions of dollars in savings for plan sponsors. Healthee approaches fraud, waste, and abuse recoupment before and after significant financial losses, using our AI to improve detection accuracy with every automated claims review while minimizing false positives.

Rely on AI to recover plan spend

The difference lies in our hands-on, proactive approach to recoupment. Unlike other payment integrity solutions, Healthee manages the entire recovery process from suspicion to money back to the plan sponsor. Our engine provides clear evidence and insights that the Healthee recoupment team can immediately act upon.

Best of all, Healthee’s model is pay-for-performance. Employers only pay when dollars are recovered. No hidden fees. No recoupment, no cost.

Healthee does the heavy lifting, reaching out to providers and leveraging in-house clinical staff to review medical and pharmacy bills. We also work hand-in-hand with your TPA and have direct relationships with most major and independent TPAs in the U.S.

Adaptive fraud-detecting AI agents

Learns from millions of data points, improving with every loop while engineering for accuracy to detect with precision and minimize false positives. Our proprietary engine continuously evolves its detection capabilities, identifying new fraud patterns as they emerge across the healthcare ecosystem.

The AI engine covers multiple high-impact categories, such as room and board, ICU, nursery, pharmacy and drugs, laboratory services, imaging, and much more.

Detect FWA with confidence

Healthee exposes FWA patterns and schemes that audits and humans may miss. Traditional audits typically catch only the most obvious fraud cases, leaving subtle waste patterns completely undetected. Healthee’s AI identifies complex billing anomalies, potential collusion patterns, and systematic waste then surfaces them for recoupment.

Performance-based alignment

Employers only pay when savings are realized through our post-payment recovery process with transparent reporting of recovered dollars and ROI. No hidden fees. No recoupment, no cost.

Healthee manages the entire recovery workflow, from evidence gathering to TPA coordination, ensuring recovered funds flow directly back to your plan. This risk-free model means our success is directly tied to your bottom-line impact, with detailed reporting showing exactly how much you’ve recovered and saved.

Discover the capabilities of Healthee app

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