Unlocking Millions in Fraud Prevention

A healthcare payer processing 2.8 million claims annually (valued at $200 million) was failing to detect a significant portion of fraudulent claims. Before implementing Lantern’s AI Fraud solution, their fraud detection system identified only 133 fraudulent claims per year – less than 0.00005% of all claims.

The Hidden Problem 

• Industry estimates suggest that 2-10% of claims are fraudulent, meaning our client was likely missing 56,000-280,000 fraudulent claims annually.
• This failure to detect fraud led to potential revenue losses of $4-$20 million per year.

AI-Powered Results 

By leveraging Lantern’s AI Fraud solution, the client is uncovering hidden fraud at an unprecedented scale, driving major financial impact.

• 7.5x More Fraud Cases Identified Per Year – AI uncovered 1,000 likely fraudulent claims in just one year, compared to 800 cases over the previous six years combined.
• 65x Increase in Fraud Value Detected – AI-flagged fraudulent claims in one year totaled $2.4 million, a massive jump from the $37,000 in fraud detected per year under the old system.
• Faster, Smarter, Scalable – With AI continuously learning, fraud detection will only improve, preventing millions in revenue loss annually.