Workers’ Compensation Fraud costs $30 Billion every year!

Aquila can help you

find and save

a good percentage of that

Aquila ~ Aquila,  is derived from Latin, means Eagle, known for its sharp eye.
Aquila, a more modern and intelligent solution to identify fraud. 

Overview of Aquila

Addressing fraud and non-compliance for worker’s compensation and health care industry using big data, cloud and AI 

Aquila identifies fraud and suspicious behavior, accurately quantifies the impact, and provides actionable insights. Aquila is also a powerful tool to help reduce costs and improve ROI

Efficient data loading and transformation reduces overall data processing time

Aquila’s built in data ingestion adaptors efficiently uses ELT methodology for faster loading of data from variety of sources and process the data using intelligent algorithms to achieve results in relatively short time. Generate instant custom reports as per business requirements for internal use and external collaboration. Aquila does the heavy-lifting for you so you can focus on next steps, gather evidence and close cases astonishingly quickly

Proactively investigate fraud cases rather than spend time looking for one

Aquila’s advanced technology platform performs human intelligence tasks to glean insights and make them ready for use by decision-makers. Seek out clarifications on suspicious activities in an informed way, adjust payments faster, and prevent fraud from spreading its tentacles.

Automatically manages provider profiles to cut down on administrative work

Why bury your head in data when an intelligent assistant can do it more quickly and accurately for you? Aquila automatically gathers and updates data to provide you with the latest view, perform accurate claims analytics, and keep you in the loop at all times.

Lessens the dependency on the IT team by over 80%

Eliminate the time spent consulting between IT and investigative teams. By making fraud investigation teams self-sufficient, Aquila also reduces the burden on an otherwise limited or over committed IT team.

How It Works

Here are 3 simple steps to get Aquila to intelligently work for your business

Explore

In this discovery phase Aquila will discuss the challenges faced by clients and work with them to develop a strategy and roadmap based on their business needs.

Engage

In this phase Aquila and client will conduct a proof-of-concept to validate value and requirements.

Execute

In this phase Aquila helps companies implement Aquila platform to identify fraudsters by detecting billing irregularities and further support them to apply advanced analytics.

Salient Features

Billing Information

Analyze medical claims and bills across various jurisdictions by using a general view and then drilling down to go deeper into more specific layers of the data. Examine billing details of a specific claim from a selection of millions of claims records in mere seconds. Identify top providers across various geographic areas and their billing patterns based on the services they provide.

Reports

Generate canned as well as adhoc reports rapidly by slicing and dicing the data based on various attributes of claims and bills. Get a deeper insight into the data by getting answers to the business questions/problems by querying the data and generating reports that facilitate fraud investigations. Build your own use cases without help from IT.

Claims Analytics

Analyze potential fraudulent claims and bills based on the fraud indicators identified by the built-in use cases such as excessive services, unbundling, referrals, doubling billing, treatment not rendered etc. Saves a lot of time for the user by analyzing large volumes of data and presenting the potential fraudulent claims by classifying them in various categories of fraud.

Provider Profile

Get a 360-degree view of a provider profile and score them based on their billing history, overall standing, and credibility in worker’s compensation industry and their relationship with the insurance agency. Keep the fraudsters on the watch list thus preventing the release of payment to the providers who are suspended by law from worker’s compensation system due to indictment or conviction.

Link Analysis

Presents the relationships between various entities in a worker’s compensation claim in a graphical way. Efficiently identifies the relationship of fraudsters with other providers by associating them via common entities or relations. This feature of network visualization can be used as part of a wider fraud management effort to increase efficiency and effectiveness.

Take Aquila for a pilot run?

Talk to our experts to setup a pilot run for your special investigative unit

Why Aquila?

Plug-and-Play Functionality

The present technology marketplace for workers’ compensation insurance fraud detection is meager. Although some big technology players provide solutions in this niche, their products don’t offer the feature-rich, plug-and-play functionality that Aquila offers. Companies that source fraud detection solutions from software giants often integrate tools and further customize those solutions.

AI and Machine Learning Capabilities

Aquila is a proprietary solution purpose-designed to solve the key problems in proactively identifying fraud. Unlike older solutions in this niche, Aquila incorporates new technologies that drive meaningful automation and deliver better outcomes. As AI and machine learning synthesize data to identify patterns and find connections, you can reserve human intelligence for higher-value work and action steps to reach fraud detection goals faster.

Backed by Seasoned Veterans

Aquila has been envisioned by an industry veteran with over 20 years of experience in the insurance fraud domain and developed by a team of over 150 insurance fraud experts. It fills a space that has few new technology-driven solutions and one that is ripe for take-off in an era of increasing fraudulent insurance claims.

Why Aquila?

Plug-and-Play Functionality

The present technology marketplace for workers’ compensation insurance fraud detection is meager. Although some big technology players provide solutions in this niche, their products don’t offer the feature-rich, plug-and-play functionality that Aquila offers. Companies that source fraud detection solutions from software giants often integrate tools and further customize those solutions.

AI and Machine Learning Capabilities

Aquila is a proprietary solution purpose-designed to solve the key problems in proactively identifying fraud. Unlike older solutions in this niche, Aquila incorporates new technologies that drive meaningful automation and deliver better outcomes. As AI and machine learning synthesize data to identify patterns and find connections, you can reserve human intelligence for higher-value work and action steps to reach fraud detection goals faster.

Backed by Seasoned Veterans

Aquila has been envisioned by an industry veteran with over 20 years of experience in the insurance fraud domain and developed by a team of over 150 insurance fraud experts. It fills a space that has few new technology-driven solutions and one that is ripe for take-off in an era of increasing fraudulent insurance claims.

Key Benefits

Here are some key benefits as to how Aquila can help your Special Investigative Unit

Catch hard and soft fraud with 20 different use cases

Close fraud cases faster than competitors

Improve operational efficiency significantly

Save several hours of fraud identification effort each week

Generate and share reports at an accelerated pace

Leverage a robust reporting system

Understand network activities with a single glance

Keep a track of healthcare ecosystem actors easily

Complete audits successfully

Did You Know?

More than one in 10 small business owners are concerned an employee will fake an injury or illness to misuse workers’ compensation benefits.

$7.2B

Annual workers compensation insurance fraud amount is estimated by The National Insurance Crime Bureau (NICB)

1/10

Small business owners are concerned an employee will fake an injury or illness to misuse workers’ compensation benefits.

94%

American businesses carrying workers’ compensation insurance and fraudulent claims deliver a significant economic blow

Testimonials

Here is what a few of our clients have to say about Aquila

Support

Here is how we support you

The Aquila Platform comes with the promise of world-class support offered to our clients through both phone and emails.

Let's make worker's compensation fraud detection

Simple & Fast