The healthcare system processes millions of medical claims every day. Manual auditing is slow, expensive, and prone to human error — and traditional rule-based systems often fail to spot subtle fraud or billing anomalies.

The Challence

Healthcare claims data is:

• High-volume, with thousands of daily submissions

• Highly variable, due to different procedures, coding systems, and payer rules

• Vulnerable to fraud, abuse, upcoding, and duplication

• Difficult to audit consistently using static rules or sample-based reviews

Traditional audit systems:

• Can’t scale effectively

• Struggle with pattern recognition in large datasets

• Rely heavily on predefined rules and thresholds, missing context

Quantum-Inspired Solution

HessQ applies quantum-inspired logic to the audit process using QUBO optimization.

Increased Accuracy

Detects more true billing anomalies and uncovers complex fraud patterns often missed by traditional audits.

Audits are completed in minutes — not hours — enabling real-time insights and faster claim decisions.

Reduces unnecessary manual reviews by minimizing false alerts, allowing teams to focus on the claims that truly matter.

Faster Processing

Fewer False Positives

The Result:

• Higher accuracy in identifying true billing anomalies

• Faster processing, with results in minutes instead of hours

• Fewer false positives, reducing manual review workload

• Improved detection of subtle and organized fraud patterns