Healthcare Fraud Shield

Healthcare Fraud Shield Healthcare Fraud Shield provides fraud, waste, abuse and error (FWAE) consulting services for the healthcare industry.

Our team has extensive expertise in fraud detection technology, prevention and management. Healthcare Fraud Shield provides new and unique Fraud, Waste, Abuse and Error (FWAE) automated solutions to the healthcare industry. Our exclusive data solutions and investigative expertise deliver maximum results in the detection and prevention against fraud. Leveraging our comprehensive fraud experience, w

e deliver fresh insights and new approaches to combat the largest challenge of our time - the delivery of honest, efficient and compassionate healthcare.

AI isn’t replacing investigators, auditors, or analysts.It’s helping them work faster, connect patterns sooner, and spen...
06/05/2026

AI isn’t replacing investigators, auditors, or analysts.

It’s helping them work faster, connect patterns sooner, and spend less time buried in manual review.

The best fraud detection strategies still rely on human expertise. AI is just the tool helping teams scale that expertise more effectively.

Thinking about building your own FWA detection tool in-house?Before you commit months (or years) of development, ask you...
06/04/2026

Thinking about building your own FWA detection tool in-house?

Before you commit months (or years) of development, ask yourself the hard questions. Because FWAE isn’t just a tech problem, it’s a high-stakes, high-speed compliance and cost containment issue.

âś… We put together a checklist of critical questions to help you pressure-test your build vs. buy decision. đź”— Download it here:https://www.hcfraudshield.com/wp-content/uploads/2026/06/HCFS_SOC_051_InHouseChecklist.pdf

🌿Plant of the WeekFrom the garden of Mandi Cook, Senior SIU Clinical Investigator Zora Neale Hurston said, "Trees and pl...
06/03/2026

🌿Plant of the Week
From the garden of Mandi Cook, Senior SIU Clinical Investigator

Zora Neale Hurston said, "Trees and plants always look like the people they live with, somehow."

If that's true, then my garden says I am a fan of organized chaos. It is not perfectly manicured. Fighting against the inevitable w**d is like swimming upstream. I prefer to work with nature by filling all of the empty space with flowers that attract pollinators, lettuces that appreciate the shade, radishes whose roots aerate the soil, and herbs that repel pests. As a result, my only "w**d" is white clover, which I allow because it fixes nitrogen into the soil for my leafy greens. Plus, less empty space means less water evaporation. My garden prioritizes functionality over sterile perfection. It's pretty, but not artificially so.

I'm on the cusp of zone 6b/7a. This means the usual summer show-stoppers like tomatoes, peppers, and cucumbers are not much to look at this time of the year. Instead, I'm featuring some of my favorite herbs:

🌾German Chamomile: This annual is a prolific self-seeder. One plant from last spring produced 5-6 volunteers this year. The leaves and flowers smell like apple Jolly Ranchers. Harvest flowers in the morning for optimal flavor. Dry them out for a few weeks, and have yourself a nice cup of evening tea to help you wind down for bed. I blend mine with mint or lavender from the tea garden.

🌻Yarrow: This is a native perennial named after Achilles (Achillea) because he supposedly used it to stop bleeding on the battlefield. When taken as a tea, it is said to reduce fevers and inflammation, and aids in digestion. Its high value nectar attracts pollinators.

🌱Chives: This perennial is not only tasty on eggs and potatoes, it also deters garden pests like aphids and Japanese beetles. Chive blossoms are also edible (and more subtly flavored); they can be used to make compound butter, infused vinegar, and finishing salt.

🌺Borage: This hardworking annual is as functional as it is pretty. It attracts nectar loving critters which help pollinate strawberries, tomatoes, and cucumbers while repelling the dreaded tomato hornworm. Its long taproot mines minerals (particularly potassium) deep from the soil, making its leaves perfect for mulching tomatoes. And best of all, the flowers and leaves taste just like cucumbers.

Healthcare fraud prevention is changing fast, and a lot of health plans are feeling the pressure to keep up. Teams are e...
06/02/2026

Healthcare fraud prevention is changing fast, and a lot of health plans are feeling the pressure to keep up. Teams are expected to identify risk earlier, work faster, and avoid drowning investigators in alerts.

That is one reason AI has become such a major conversation across healthcare payment integrity right now. Industry leaders and federal agencies are increasingly focused on how AI can help identify suspicious billing behavior earlier and improve fraud prevention efforts before losses grow.

But technology only helps if it actually makes investigators’ jobs easier.

At Healthcare Fraud Shield, that’s the focus behind our AI-powered HCFSPlatform. The goal is to help SIU, compliance, audit, and PI teams spend less time sorting through noise and more time focusing on the cases that truly matter.

That is where the industry is heading.

🎧 Fraud schemes are changing fast. Stay ahead with The F Files Podcast from Healthcare Fraud Shield.From suspicious bill...
06/01/2026

🎧 Fraud schemes are changing fast. Stay ahead with The F Files Podcast from Healthcare Fraud Shield.

From suspicious billing patterns to emerging AI-driven detection methods, The F Files delivers practical insight for healthcare investigators, auditors, coders, and payment integrity professionals.

👉Listen now on Spotify and major podcast platforms.
https://www.hcfraudshield.com/podcast/

05/29/2026

Every team has had this moment. The spreadsheet crashes. Nobody saved it. The investigation continues anyway.

There’s a reason more teams are moving beyond manual workflows and into AI-powered analytics.

🌱 Introducing HCFS Plant of the Week 🌱Each week, we’ll spotlight an HCFS employee’s favorite plant, garden, or harvest a...
05/28/2026

🌱 Introducing HCFS Plant of the Week 🌱

Each week, we’ll spotlight an HCFS employee’s favorite plant, garden, or harvest along with photos, care tips, success stories, and occasionally a cautionary tale involving overwatering.

Too many organizations still treat prepay and postpay as separate strategies.A claim may bypass prepayment review, get p...
05/27/2026

Too many organizations still treat prepay and postpay as separate strategies.

A claim may bypass prepayment review, get paid, and only surface months later during recovery efforts. By then, the financial impact, provider abrasion, and operational cost are much higher.

Modern payment integrity requires connected visibility across the entire claim lifecycle.

🛡️ PreShield helps stop high-risk claims before payment using configurable real-time logic and AI-driven analytics.

🛡️ PostShield helps identify the fraud, waste, abuse, and error activity that slips through after payment with integrated workflows and intelligent detection.

When prepay and postpay work together inside one ecosystem:
• Detection improves
• False positives decrease
• Investigations move faster
• Teams gain stronger visibility into evolving patterns
• Organizations recover and prevent more dollars

Fraud schemes do not operate in silos and neither should your detection strategy.

Investigators don’t want more alerts, more spreadsheets, or more disconnected systems. They want better leads, faster re...
05/26/2026

Investigators don’t want more alerts, more spreadsheets, or more disconnected systems. They want better leads, faster reviews, fewer false positives, and tools that actually help them close cases.

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