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Uncover Hidden Healthcare Fraud with AI-Powered Data Unification
For payers, risk providers, and ACOs: Aggregate deidentified data to detect undetected FWA, remove bad actors, and boost savings across Medicare, Medicaid, and ACA—no risk.
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FWA Strains for Payers, Risk Providers, and ACOs - Profero's Fix
Aggregate
Data
Unified
Insights
Savings for
Your Model
The Opportunity
Current State: Limited Focus on FWA
- Minimal proactive emphasis: Payers and risk providers miss 90%+ undetected FWA due to siloed data and resource constraints
- Inability to aggregate cross-payer insights: Reliance on single-payer audits prevents spotting patterns across insurers and LOBS
- III-equipped SIUs overlook waste/abuse which erodes profits
- Regulatory gaps: Despite CMS's 2025 push payers face MFCU disincentives but lack tools for collaborative, evidence-based actions
- Outcomes: Increased Medical costs, delayed recoveries, retained bad actors, and strained networks/patient care
Future State: Empowered Detection with Profero
- Heightened proactive focus: Al agents aggregate deidentified data across payers, detecting 40% more hidden FWA
- Seamless cross-payer aggregation: Pre-built normalization logic unifies insights quickly, enabling multi-payer collaboration
- Targeted fraud analytics: Specialized agents flag inappropriate claims and assist with recoveries
- Regulatory alignment: Evidence-based cases support CMS/MFCU compliance, with agentic processes for faster resolutions and human-in-loop oversight
- Outcomes: 5x detection rate, 30-50% waste reduction, run-rate savings, cleaner networks, and multi-stakeholder benefits
Why Profero for Your Organization?
Cross-Payer Aggregation
Cross-Payer Aggregation
Cross-payer unification to spot FWA across payers
AI Detection Agents
AI Detection Agents
AI Agents analyze data and escalate FWA to humans
Trusted Agent
Trusted Agent
Profero can support evidence-based conversations leading to long-term savings
Ready To Protect Your Bottom Line?
Payers, risk providers, and ACOs: Start detecting hidden FWA today. Risk-free pilot.
“Profero’s team helped to aggregate our payer’s data to support both claim recovery and re-contracting on risk contracts.”
– VP, Medical Economics (Risk Provider)
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