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Healthcare Fraud Detection Using Data Analytics, AI & Machine Learning

Healthcare fraud, waste, and abuse (FWA) continue to pose major financial and operational risks to insurers, healthcare providers, and regulators worldwide. This training provides a practical, business-focused introduction to how data analytics, artificial intelligence (AI), and machine learning (ML) can be used to detect, investigate, and prevent healthcare fraud effectively.

Participants will explore real-world fraud schemes, healthcare data complexities, and investigative methodologies, while learning how to apply analytics tools—from dashboards and KPIs to predictive and anomaly detection models. The program combines case studies, hands-on exercises, and real industry examples to ensure immediate applicability in both public and private healthcare systems.

Training Outlines

Module 1: Healthcare Fraud, Waste & Abuse (FWA) Fundamentals

Overview of healthcare fraud and its economic impact

Common fraud schemes (local, regional, and global)

GCC vs Western healthcare systems

UAE regulations and legal implications for audit and recovery

Module 2: Healthcare Data Foundations

Types of healthcare data used in fraud detection

Data collection, integration, and preparation

Healthcare data challenges and quality considerations

Module 3: Data Analytics for Fraud Detection

Descriptive and diagnostic analytics

Exploratory data analysis (EDA)

Data visualization best practices

Fraud detection dashboards and storytelling with data

Module 4: Machine Learning & AI in Healthcare Fraud

AI vs Machine Learning vs Deep Learning vs Generative AI

Business rules–based detection

Supervised learning for fraud detection

Anomaly detection and rare-event modeling

Module 5: Advanced Applications & Case Studies

Predictive and prescriptive analytics use cases

Real-time and pre-pay fraud detection

Monitoring fraud detection programs

Group case studies and participant use cases

Tell us about your enquiry today

Why 4D?

4D Training & Consultancy delivers practical, industry-driven programs that go beyond theory to focus on real-world application and measurable impact. Our trainings are led by senior practitioners with deep experience across analytics, AI, and complex business environments, ensuring participants gain insights they can immediately apply in their roles. We combine case studies, hands-on exercises, and interactive discussions to bridge the gap between data, investigation, and decision-making, while maintaining flexibility to tailor content to organizational, regulatory, and operational needs.

Frequently asked questions

Trainings FAQs

We provide a tailor-made offer for each requirement. For example, if you're a company wanting to train multiple people, we provide a special offer per person and might charge per day rather than per person for large numbers, which would be more beneficial for you. If you are an NGO with a big number of participants, we can also significantly reduce the price per person. If you want the training in a specific venue (like a hotel or event space), we take that into consideration and would be responsible for all arrangements. Rest assured, our prices are among the most competitive in the market and we never like to lose a client. Register your interest and our team will be in contact within 24 hours.

Absolutely! We strongly recommend and provide pre and post-training assessments to ensure the tangible impact and effectiveness of our programs. For instance, we can deploy a mystery shopper experience both before and after a training initiative. This allows us to gather objective data on how the training has influenced real-world performance, customer interaction, and overall skill application within your team. This direct comparison provides invaluable insights into the return on your training investment and helps fine-tune future development strategies.

Our tailor-made trainings are designed to ensure direct applicability to your daily work. We achieve this by incorporating examples, interactive games, practical exercises, and relevant case studies that truly resonate with the trainees. This approach helps them bridge the gap between theory and real-world application. Our consultants don't just present information; they draw from their extensive experience, and crucially, from yours, to develop and apply customized solutions that truly work.

The duration of our 4D's programs is finely tuned to their specific objectives. For training designed to culminate in an international certification from a recognized entity, we adhere to the protocols and timeframes mandated by the certifying body. However, for our bespoke, tailor-made solutions aimed directly at enhancing performance and organizational capabilities, the duration is highly flexible, ranging from intensive one-day workshops to comprehensive two-week programs, all designed to deliver optimal impact and tangible results.