How AI Is Transforming Healthcare Fraud, Waste, and Abuse from Detection to Prevention

Healthcare organizations face mounting pressure as fraud, waste, and abuse (FWA) drain billions annually while legacy detection models struggle with data complexity, evolving regulations, and tightening margins. Rules-based approaches are insufficient in fragmented payer environments.

This white paper explores how healthcare organizations can combine enterprise workflow orchestration with healthcare-native agentic AI to shift from reactive investigations to proactive prevention. Topics include:

• Automating evidence collection to accelerate investigations
• Using AI to detect emerging fraud patterns
• Embedding governance into AI operations
• Scaling compliance without added administrative burden