Healthcare and Wellness...Unified

Home

The Mission

Our Mission is to offer healthcare providers a unique AI platform to protect their businesses from fraud and embezzlement, and help grow their revenues.

The Problem

Embezzlement in the healthcare industry is a rampant issue without an apparent, simple solution. The US spends more that $2 trillion on healthcare annually and at least 3% of that spending - or $68 billion - is lost to fraud each year [1][2]. For example, in dental industry itself, embezzlement is crippling 60% of dental professionals who, on average, suffer a yearly loss of $110,000 per office [3]. With over $250 billion spend on dental care annually, around $12.5 billion, 5%, is lost to dental fraud and abuse. It is a huge unsolved problem [4][5] Ensuing lawsuits, insurance fraud investigations, field police cases, and customer losses are additional, unquantifiable emotional and financial costs. There are not enough safeguards in the existing practice management systems to detect and prevent embezzlement. On top of that, the chance of costly accounting mistakes occurring is higher than ever before due to manual tracking and integration of ever-changing conditions (ADA codes, insurance rates, patient history, etc.). This leads to data integrity issues and exposes the practice to embezzlers who can manipulate the systems and steal.

Solution

Our team understands the frustrating realities of running a healthcare business and the importance of providing exemplary patient service each and every time for all patients. In an effort to solve the embezzlement issue across the healthcare industry, we have started by focusing on the dental industry, which is one of the biggest healthcare sectors affected by financial embezzlement. Our product features cover can be categorized into:

Fraud detection for doctors:

Our first feature-set offering tackles the rampant financial embezzlement issue head-on. We integrate seamlessly with Practice Management System and run our proprietary AI anomaly detection algorithms to detect and report fraudulent transactions. Built from scratch with strong focus on end-to-end privacy and security controls, we are HIPAA compliant and take pride in protecting the integral assets of doctor’s business - patient records.

Financials for doctors:

Knowing how your practice is performing in terms of collections, production and adjustments is the key metric used by every healthcare professional in their businesses. We provide a easy-to-use financial dashboard for the doctors. Monthly, quarterly and yearly financials can be reported out for accounting purposes or taking a pulse of the business health.

Business Analytics using AI/ML:

How to grow my revenue? Which treatments should I focus on? What skills are missing that I need to acquire to serve my patients better and add new revenue streams? Where are my growth opportunities? These are the most commonly asked questions by doctors and our AI analytics answers all these questions. This epitomises our mantra - “Healthcare and wellness...unified”.

Analytics for Insurance companies:

Fraud and embezzlement has huge impact on insurance companies and drives their costs up. Our analytics can serve Insurance companies to understand the current trends in oral healthcare industry, identify patterns that can highlight fraudulent behavior and thereby they can become close partners with doctors to curb this widespread embezzlement issue. Our vision is to create a win-win ecosystem for the trio of doctors, patients and insurance companies

Cross-Pollinate Analytics:

Privacy and security is our topmost value. We also understand that for healthcare industry to stop fraud, we need to compare data between different doctors and understand the analytics behind it. Our algorithms carefully carve out all the PHI data and performs cross-pollinate analytics between doctors. This insight is critical for both doctors and insurance companies to fight fraud. It also empowers them to drive profitability without driving costs to their customers: patients. Our HIPAA compliant solutions on multiple form factors protects doctors from financial embezzlement in their healthcare offices. Our initial product offering is for dentists. We have developed our first AI based, HIPAA compliant product for the oral healthcare industry to solve the $12.5 billion embezzlement issue and are currently testing it in few dental offices.This includes identifying and addressing data integrity issues through auto-detection, resolution and training to dentists and front office employees.

Growth Opportunities and Market Expansion

As a growth strategy, our plan is divided into 3 stages. Stage 1: Provide a rich set of big-data analytics/AI to the entire dental industry ($250 billion annual spend) encompassing dental-care practitioners and insurance companies, thereby enabling fraud prevention and driving revenue growth. Stage 2: Use the latest technology to connect healthcare insurance companies, doctors and patients to detect fraud across other health care market segments e.g. Optometrics, Veterinary clinics, etc. Utilize AI/ML to identify avenues for revenue growth and drive profitability. Stage 3: Become healthcare industry central resource platform enabling health information proficiency, health decision aids and all healthcare transaction integrity. Continue to maintain industry lead with the best-priced and innovative software features and an excellent customer service experience.

Some Key Competitive Advantages

First-of-its-kind HIPAA compliant software solution that prevents office embezzlement. Lowest cost for additional features like financial metrics, visualization of revenue growth opportunities, and finances on mobile platforms Covers 85% of the dental market share in terms of dental practice management software used (Dentrix, Eaglesoft) It can be easily deployed into parallel health segments like optometry, cosmetic surgery offices, and more.

References

[1] National Health Care Anti-Fraud Association, 2008
[2] https://www.deltadentalins.com/dentists/guidance/fight-fraud.html#f1
[3] https://www.oralhealthgroup.com/features/embezzlement-every-brilliant-clinician-know/
[4] https://www.ada.org/en/science-research/health-policy-institute/dental-statistics/workforce
[5] https://www.phmic.com/dental-fraud-12-5-billion-dollar-problem/
[6] https://www.dentistryiq.com/articles/apex360/2018/05/true-dental-fraud-the-westerner.html
© 2020 AIHealth Inc.
Facebook Twitter Instagram LinkedIn
1206 Mountain View-Alviso Rd
Suite #A
Sunnyvale, CA 94086
408-338-7511