Smart Applications unveils AI platform to curb healthcare claims fraud

NAIROBI, Kenya, May 8 – Smart Applications International has launched a new artificial intelligence-powered platform aimed at reducing fraud, waste and abuse in healthcare claims processing as insurers and healthcare providers seek to improve efficiency and cut financial leakages.

Dubbed Smart Detect AI, the system uses machine learning, behavioural analytics and clinical logic to analyse healthcare claims before and after submission in order to identify suspicious patterns, improve accuracy and strengthen decision-making across the healthcare value chain.

The platform enables insurers to flag unusual billing patterns, possible collusion between members and healthcare providers, abnormal hospital visit frequencies, clinical inconsistencies and location anomalies that may point to fraudulent claims.

According to the company, the solution is designed to support earlier detection of hidden risks, allowing insurers to undertake targeted investigations and reduce losses linked to fraudulent or exaggerated claims.

Speaking during the launch, Smart Applications International Head of Data Analytics Barbara Simiyu said healthcare systems are processing growing volumes of claims, making it increasingly difficult to manually identify hidden risks.

“Healthcare systems today process claims at scale, but critical risks often remain hidden,” she said.

“Smart Detect AI introduces a new level of intelligence that enables stakeholders to move from reactive to proactive claims intelligence — strengthening transparency, improving efficiency and ultimately protecting the integrity of healthcare systems.”

The solution was unveiled during the fifth Smart Summit, with the firm positioning the platform as part of wider efforts to improve healthcare system accountability and operational efficiency in Kenya and across Africa.

The launch comes at a time when healthcare institutions and insurers are increasingly embracing artificial intelligence and data-driven systems to manage rising healthcare costs, improve patient outcomes and reduce fraud-related losses.

Smart Applications International said the technology would help insurers and healthcare providers optimise operations while improving service delivery to patients.

The company, which operates in 11 African countries, provides biometric and digital healthcare solutions to governments, hospitals, insurers and private institutions.