MediBuddy brings an AI-powered tool, 'Sherlock' to combat healthcare fraud and promote cashless solutions

MediBuddy, India’s largest digital healthcare platform, has introduced 'Sherlock,' an AI-driven fraud detection system designed for healthcare reimbursement claims. This system leverages artificial intelligence (AI), machine learning (ML), and data analytics to detect and prevent fraudulent claims in real-time, transforming the reimbursement process for healthcare providers, insurers, and patients.

Fraudulent activities extend beyond financial loss, affecting reputation and attracting regulatory attention. To combat Fraud, Waste, and Abuse (FWA), MediBuddy combines a broad cashless network with Sherlock’s advanced detection capabilities, potentially reducing costs by up to 20%. This reduction includes a 10% savings from the cashless network and another 10% from Sherlock’s fraud detection.

Sherlock’s AI and ML algorithms provide real-time analysis and alerts, identifying potential errors or fraud before they happen. The system is adaptable to different organizations' needs, detecting issues like claim duplication, document tampering, and pricing discrepancies. Key features include advanced AI and ML algorithms for accuracy, real-time alerts, pattern recognition for fraudulent activities, and user behavior monitoring.

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