How AI Saves Time in Worker’s Compensation Fraud Detection

In the area of worker’s compensation fraud detection, AI-powered software is making the identification of fraudulent activity and the overall fraud management function efficiently.

Generate critical reports within minutes

When an individual or an external agency tip-off special investigating unit then proving it with sufficient documentation is the logical next step. But sifting through mountains of data to find every bit of information related to the case is time-consuming. Not only must data be collected, but also communicated effectively through simple reports.

An AI fraud detection solution creates instant reports from various data attributes. The software responds to your data attribute preferences and collates the information you seek into ready-to-use reports that you can export or save – all in a matter of minutes.

Claims analytics is faster

Spotting red flags in large swathes of physician, facility and patient data will naturally take up enormous amounts of time. Making connections between fraud participants is also both time-consuming and complicated.

AI-powered fraud detection solutions can do a deep dive into data to identify red flags and fraud indicators. They can bring up information on billers instantly, including excessive visits, treatment not rendered and provider licensure issues.

Billing and provider information at your fingertips

AI-powered fraud detection software also provides instant information and visual representations of red flags in billing and provider data. If there is a spike in bill counts, the software will represent it graphically. If the provider has upcoded and overbilled, the software will include these red flags alongside other provider data, such as NPIN, specialty and Tax ID. In short, user can examine claims and providers deeply without the need for any legwork, saving user’s substantial time.

See relationships between insurance ecosystem entities

To understand how a hospital is related to a physician or patient, you need to match multiple sets of information. Artificial intelligence takes over this task and goes further by visually representing – via graph, map or tables – the connections between various participants in the insurance ecosystem. This capability generates ‘aha!’ moments and helps you join the dots to see the full picture quickly.


The Aquilla platform leverages Artificial Intelligence and Machine Learning to assess healthcare data for suspicious patterns and proactively detects workers compensation fraud, Saving Insurance Companies Millions of dollars and weeks or work.

To make worker’s compensation fraud detection – Simple & Fast, request a demo HERE

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