Case Study: Large National Health Plan detects 97% of FWA exposure with Codoxo Fraud Scope

Codoxo Validates Fraud Scope Catches 97% of Post-Payment Exposure

Large National Health Plan worked with Codoxo and its Fraud Scope AI-based fraud, waste, and abuse (FWA) detection platform to better understand a growing number of high-risk alerts and large dollar amounts of paid exposure appearing on the dashboard. The plan wanted to know whether Fraud Scope could have identified the same leads found through hotlines, law enforcement, other vendors, and internal manual efforts.

Codoxo conducted a comparison study using Fraud Scope as a standalone tool to test its ability to surface and prioritize FWA leads. The platform captured approximately 97% of total exposures, flagged only 8% of providers, and identified additional high-potential leads missed by other tools, helping the health plan focus resources on the highest-risk cases and reduce false positives and provider abrasion.