MutuGuard helps mutuelles and health insurers reduce invisible reimbursement leakage using behavioral analysis, automated member verification, and AI anomaly detection — all in the pre-payment window.
240+
Decisions / sec
98.4%
Auto-block precision
4.2s
Median latency
M. Dubois → Vision Optique Paris
€680
risk 84%
A. Benali → Cabinet Kiné Bordeaux
€55
risk 6%
S. Laurent → Clinique Dentaire du Sud
€1,820
risk 93%
P. Moreau → Sourire Dentaire Strasbourg
€980
risk 71%
C. Fournier → Optic 2000 Rivoli
€410
risk 22%
Prevented this month
€218,420
Auto-blocked
2 184
this week
Verifications
892
83% replied
Fraud rate
3.4%
post-MutuGuard 1.0%
Median TTD
4.2s
time-to-decision
Built with and for anti-fraud teams
Health insurers lose billions every year to fraudulent reimbursements — inflated invoices, undelivered care, provider rings, duplicates. Estimates put the exposure at roughly €2.7B for French complementary insurers and ~€56B to healthcare fraud across Europe (ALFA and EHFCN estimates). By the time fraud is detected, the money is already gone.
Existing tools only alert once the transfer has gone out — recovery is slow, partial, and adversarial.
Fixed thresholds miss evolving patterns: invoice mills, multi-provider rings, abnormal velocity.
Teams see isolated claims, never the member ↔ provider ↔ cluster graph that reveals collusion.
Calling every member doesn't scale. Without automated verification, investigation grinds to a halt.
MutuGuard intercepts every reimbursement request before payment. Three modules work together to produce a defensible, traceable, explainable decision.
A dynamic profile per member: reimbursement velocity, care frequency, provider relationships, deviations from history.
When doubt is serious, MutuGuard sends a contextual SMS: “Did you actually receive these glasses?”. Simple answer. Clear decision.
Anomaly detection, provider/member clustering, a relationship graph, and continuous learning from your decisions.
Every reimbursement request runs through the same deterministic, auditable pipeline. No payment is released without passing through MutuGuard.
Claim ingested
API · TPAdmin · SFTP
Behavioral profiling
Member baseline · velocity
AI risk score
Anomaly + supervised + cluster
Decision router
Approve · Hold · Verify · Block
Member verification
SMS · email · push
Final decision
Signed JSON · audit log
240+ decisions per second, p99 latency < 80 ms. Decision returned before the payment batch goes out.
Interactive visualization of member ↔ provider links. Automatic detection of fraud rings.
Every decision comes with the top risk features, in plain language, ready for the investigator or a regulator.
Localized SMS / email / push templates, member variables, and multi-stage workflows.
A dedicated console: timeline, linked claims, AI recommendation, one-click action, case handoff.
Chained decisions (SHA-256), exportable. Built for DPOs, internal compliance, and regulatory review.
Combine business rules, the anomaly engine, and supervised models. Versioning and A/B testing across all of them.
Multi-team routing: auto-approve, hold, verification, investigation escalation, broker notification.
Fine-grained roles (ops, investigator, compliance, exec). SAML / OIDC SSO, user-level audit.
MutuGuard targets the preventable share of fraud: inflated amounts, undelivered care, duplicates, rings. A conservative model on production-observed rates yields an ROI of > 12× in the first year.
Open the ROI simulatorReference insurer · 250,000 members
Monthly volume
65,000 claims
Average amount
€145
Observed fraud rate
3.4%
MutuGuard prevention rate
71%
Platform cost
€14,500 / mo
12-month projection
€2,304,600
fraudulent reimbursements prevented
Net savings (year)
after platform cost
€2,130,600
ROI multiple
13.2×
Break-even
2.3 months
HDS hosting, end-to-end encryption, per-tenant isolation, and SSO-controlled access. MutuGuard never stores bank details or sensitive medical data it doesn’t need.
Logical sharding + per-insurer encryption. No cross-tenant access.
PII masked for the models. Real values only on the authorized ops side.
Timestamped, hash-chained, exportable decisions.
HDS, GDPR, ACPR / EIOPA alignment.
For risk & compliance leaders
“MutuGuard finally gives us a single control point before payment. What used to take 30 days post-payment is now settled in 4 seconds — with a defensible trail.”
Head of Compliance
National health insurer · 240k members
Ready to stop the leak?
Launch the demo in 30 seconds, or request a free analysis of 3 months of your anonymized reimbursements.