Codoxo, a provider of AI and generative AI-powered healthcare payment integrity solutions, has launched Deepfake Detection, an AI-driven tool aimed at identifying AI-generated or manipulated medical documentation and diagnostic images submitted with claims before payments are processed for health plans across the U.
S.
Healthcare fraud represents a multibillion-dollar challenge, with generative AI enabling documentation fraud to scale beyond manual methods. Payers frequently rely on progress notes, clinical narratives, and diagnostic images for claim validation, and synthetic records can now be fabricated rapidly, posing a challenge for traditional rules-based systems and manual review processes.
Deepfake Detection addresses this vulnerability by integrating AI-based detection and explainable risk scoring into payer fraud and payment integrity workflows. This solution extends Codoxo’s Point Zero philosophy, which focuses on early intervention in validating documentation and evidence, not solely at the claim submission stage.
Musheer Ahmed, PhD, founder and CEO of Codoxo, stated, “Fraudsters are adapting faster than legacy defenses can respond, and healthcare’s documentation-heavy workflows make payers uniquely vulnerable. Deepfake Detection is designed to help payers fight AI-assisted fraud with AI. By identifying synthetic or manipulated medical documentation earlier, we can strengthen payment accuracy, reduce downstream recovery costs, and protect provider relationships.”
The Deepfake Detection tool analyzes documentation, images, and related claim context in seconds, providing risk indicators to payment integrity teams and Special Investigation Units (SIUs) for surfacing high-risk cases efficiently. Its capabilities include cloning and duplication detection for identifying reused medical records, partial AI-generation detection for records combining authentic and AI-generated content, behavioral cross-referencing to connect documentation with claim history and provider behavior, and continuous adaptive learning to improve detection accuracy.
Kurt Spear, Vice President of Financial Investigation and Provider Review at Highmark Inc., commented on the launch: “As generative AI becomes more accessible, verifying the authenticity of medical documentation at scale is becoming increasingly complex. Healthcare organizations need new approaches to identify synthetic or manipulated documentation earlier in the process in order to protect payment integrity and reduce downstream risk.”
This launch follows Codoxo’s recent $35 million Series C funding round, which was led by CVS Health Ventures. Codoxo’s broader Generative AI-driven Unified Cost Containment Platform offers end-to-end payment integrity and fraud, waste, and abuse solutions, covering stages from pre-claim to postpay within a HITRUST-certified environment.
