Wiz Benefícios launches AI tool to detect healthcare fraud

Wiz Benefícios, a business unit of Wiz Co specializing in corporate benefits and health, has launched an artificial intelligence tool designed to identify potential fraud in medical and clinical services. The technology was unveiled during the Campinas Innovation Week in São Paulo.

The AI solution analyzes health plan usage data to identify patterns associated with high-impact events, such as surgeries, hospitalizations, and high-cost treatments. This allows companies to anticipate certain situations and implement preventive management strategies.

Beyond analyzing plan users, the tool audits healthcare providers, including doctors and clinics. According to director José Antônio Coelho Junior, the system seeks to identify unexpected behaviors that may require investigation, such as potential conflicts of interest or irregularities in the relationship between services offered by a clinic and the procedures performed.