Healthcare fraud is a persistent challenge, quietly draining billions from the system while undermining public trust and limiting access to care.

For Esther Makandah, an AI and data expert, these issues are more than abstract problems; they are opportunities to apply intelligent solutions that safeguard both resources and the people who depend on them.

In a recent media chat, Makandah explained how traditional fraud detection methods often fall short. “Static audits and retrospective investigations catch some fraud, but the system is vast and fast-moving. Delays mean losses, and in healthcare, those losses can affect patient care,” she said.

Her work focuses on building tools that detect anomalies in real time, turning raw data into actionable intelligence for administrators, regulators, and insurers.

Central to her work is the Healthcare Fraud Heatmap Dashboard, an AI-driven platform designed to flag potential fraud across hospitals, clinics, and insurance claims.

By combining structured claims data with unstructured text fields, like provider notes and treatment descriptions, the system identifies patterns that conventional approaches might miss.

“The goal isn’t just to alert people to suspicious activity,” Makandah noted. “It’s to show why something is flagged, so decisions are informed and precise.”

The dashboard features a dynamic geospatial heatmap, allowing stakeholders to drill down by state, county, or ZIP code to see high-risk areas.

This level of detail, Makandah explained, makes it possible to allocate resources efficiently and intervene early. “When you can see hotspots and understand the drivers of fraud, you can prevent losses before they escalate,” she said.

Beyond detection, the system incorporates Explainable AI, which builds trust in the model’s recommendations.

Users can explore the reasoning behind each flagged claim, fostering accountability and confidence in the decisions made. “Transparency is essential,” Makandah emphasized.“Healthcare providers and regulators need to understand the logic behind alerts, not just the alert itself.”

The platform is also highly adaptable, capable of integrating both public datasets and user-uploaded data.

Whether used by a federal oversight body or a regional insurer, the dashboard provides tailored insights, making fraud detection faster, more precise, and more actionable.

“We aim to turn complex data into decisions that have real-world impact, protecting patients, supporting providers, and safeguarding the system,” she added.

Makandah sees the broader significance of her work beyond the dashboard. Reducing fraud doesn’t just save money; it strengthens trust in the healthcare system and ensures resources reach the patients who need them most.

“Every dollar lost to fraud is a dollar not spent on care,” she said.“By leveraging AI responsibly, we can help create a healthcare environment that is safer, more transparent, and more reliable for everyone.”

Her work exemplifies how technology, applied thoughtfully, can address systemic challenges.

Through tools like the Healthcare Fraud Heatmap Dashboard, Makandah is helping shape a future where fraud is not only detected but prevented, ensuring that healthcare systems operate efficiently and ethically for all.

Written by Esther Makandah