Case Study

How We Solved $200B Medical Overbilling with Secure AI

“Protecto enabled us to safely process claims data with LLMs without compromising privacy or accuracy, transforming our billing verification process.”

– Leading Insurance Provider

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Impact Statistics

$200B

Annual cost of medical claim overbilling addressed

10X

Reduction in data exposure risk

$10M+

Savings projected customer savings in first year

The Challenge

Combatting Inaccurate Billing Practices in the Healthcare System

Medical billing errors, such as upcoding, unbundling, and incorrect coding, cost the U.S. healthcare system over $200 billion each year. These errors create a financial burden on patients, insurance companies, and healthcare providers alike. The insurance provider needed a solution to detect and address these errors accurately while ensuring compliance and protecting patient data privacy.

highlights
The Solution

Privacy-Preserving RAG for Medical Claims

Using advanced data protection and AI to streamline medical billing.

Step 1

Ground Truth Dataset Creation

Step 2

Sensitive Data Masking

Step 3

AI-Powered Similarity Search

The Results

Realizing Millions in Savings While Safeguarding Patient Data

Successfully implemented secure, AI-powered billing verification system to combat $200 billion in medical overbilling. By ensuring PHI compliance through advanced data masking and using AI-powered billing validation, Protecto enables accurate, efficient claims processing while protecting patient data privacy.

Key Achievements

Ready to Transform Your Medical Claims Processing?

Discover how Protecto can help you combat medical overbilling while maintaining HIPAA compliance and data security.
Case Study

Download "Reducing $200B Medical Overbilling Challenge with Protecto"

Discover how Protecto’s secure AI-powered solution helped a leading insurer reduce medical overbilling by $10 million annually while ensuring full PHI data protection compliance. Learn more!