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Axel Reijmers| Managing Director
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(201) 747-4718
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Overview
4L Data Intelligence is raising $5M to stop billions in healthcare payment-related Fraud, Waste, and Abuse. Its patented Integr8 AI Risk DetectionTM detects fraud, waste and abuse beyond what legacy claims editing and analytics systems can see and delivers immediate savings for healthcare payers.
- Massive Problem: The U.S. healthcare system pays out $4.5 trillion annually1. $2502 to $7003 billion of that is estimated to be payment-related fraud, waste, and abuse (FWA) by healthcare providers
- 4L Data delivers 5-15% reduction in total claims cost3 over and above current payment integrity solutions
- Proof of Impact: In a one-year pilot analyzing 30 million paid claims for one insurer in one state, $1.5 billion in suspicious payments were flagged4, and multiple multi-year provider fraud schemes were detected
- Currently nine active SAAS contracts representing up to 30 users and $30 million deal value, plus over $100 million of additional potential deal value under discussion
The Problem: Out Of Control Fraud, Waste, & Abuse (FWA)
- FWA estimated at $250 – $700 billion in healthcare annually1
- Currently too much pay-and-chase – not enough upfront prevention
- Legacy claims data-centric editing and analytics solutions can’t see near real-time dynamic FWA including behaviors, relationships and outliers
- Fraudsters are using AI at scale – healthcare payers are falling behind
- Ineligible healthcare providers get paid because provider data is bad
- 6 billion accessible claims in the US offering a $4.0 – $11.5 billion annual TAM2
4L FWA Prevention™ Delivers Big Increases In FWA Savings1
- 5 to 15% total claims cost reduction in execution1
- Near real-time detection of complex relationships, behaviors, and patterns outside of pre-set rules and structured learning models
Integr8 AI™ Powered Provider-Centric Claims Analysis
What Current Claims/Bill
Payment Analytics Systems Do
Legacy claims data-centric editing and analytics technologies analyze lines on a single claim
What Patented Integr8 AI™ Powered
4L FWA Prevention Solution Does
4L Data analyzes every claim in the context of all current and historical claims, relationships, behaviors, patterns and outliers
Leadership Team With Complementary Experiences
TRACK-RECORD IN SOFTWARE DEVELOPMENT, BIG DATA, ENGINEERING, HEALTHCARE & COMMERCIALIZATION
Theja Birur
Founder & CTO
- Integr8 AI Risk DetectionTM inventor
- 20 years in analytics and AI
- Ontario Ministry of Health (Canada)
- California SCIF – big data / data warehouse
- IBM Innovation Lab
- MS: University of Oklahoma
Applied Math and Computer Science
Clay Wilemon
CEO & Chairman
- Founder/CEO: DevicePharm (sold to PE)
- Launched 500+ new healthcare and tech brands
- Co-founder/director of med-tech companies
- Health, technology and AI investor / venture capitalist
- Director: Octane
- BA: Vanderbilt University
Karthik Govindan
Chief Product & Transformation Officer
- 16 years in global IT services customer success
- Payer and provider payment and billing integrity
- AVP, Hexaware
- Extensive portfolio and P&L experience
- MS: Alagappa University
- MBA: IBMR
Maurice Reid, MD
Chief Medical Advisor
- BS: Howard University
- MD: University of Maryland
- Board Certified: Emergency Medicine
- Founder: Express Care Urgent Care Centers
(Sold To LifeBridge Health) - Investor in real estate, healthcare services, medical device, and healthcare technology companies
Specific Risks
- Business Risk – long sales and implementation cycles with big payers
- Other more established companies with more resources could develop competing capabilities
- Ability to attract and retain talent
- Data-breaches, platform security common to companies handling healthcare and other sensitive information
- Future regulations relating to the use of artificial intelligence in healthcare
- Intellectual Property Challenges: Risk of infringement on existing patents could lead to costly legal battles
- Private securities are speculative, illiquid, and carry a high degree of risk – including the loss of the entire investment