The lack of access to affordable and quality healthcare is widely-known to be a pain point for millions of Americans, yet the U.S. spent $4.1 trillion on healthcare in 2020 and that number is expected to exceed $6 trillion by 2028. It’s evident the national healthcare system is in need of improvements, and one place to start is by remedying the annual loss of billions of dollars due to fraudulent charges and wasteful spending.
Working to solve this problem, Atlanta-based Codoxo aims to help contain healthcare costs and protect the industry’s funds. Operating a suite of AI-powered solutions, the company closed an oversubscribed Series B round to further its offerings. The $20 million round was led by QED Investors and brings the company’s total funding to $30 million. Other participants in this round included Brewer Lane Ventures, Sands Capital Management and GRA Venture Fund, among others.
Codoxo has seen increased demand for its forensic AI product. The platform analyzes and connects data for healthcare payers and government agencies, providing them with insights that help to address fraud and payment integrity issues quickly and efficiently. The collection of tools is known as its Healthcare Integrity Suite. Codoxo also provides services like data migration and ongoing customer success.
“Each year hundreds of billions of dollars in the U.S. are lost to fraud, waste and abuse in healthcare. With millions of claims coming into healthcare organizations, it’s hard to distinguish between appropriate care, a simple coding mistake and intentional fraud,” Musheer Ahmed, Codoxo’s founder and CEO, told Built In over email. “Artificial intelligence, like that from Codoxo, is giving healthcare payers and agencies a more accurate and more timely way to detect new problems and take action to control costs before they add up to a big hit on the bottom line and the healthcare system.”
As the need persists for solutions like Codoxo, the company has recently recorded substantial growth. In 2021, Codoxo more than doubled its revenue and saw a 60 percent increase in how often its product went live for clients. Additionally, half of its existing client base chose to expand their work with the platform, according to Ahmed. Codoxo also doubled its workforce to 46 people since December of 2020, 32 of which are based in Atlanta.
Building upon this momentum, Codoxo is investing its latest funding round in fueling company growth and expanding to serve the pharmacy benefit managers market. It’s also devoting money toward advancing its products and services. To achieve these goals, Codoxo is emphasizing its hiring efforts with plans to double its team by the end of the year.
“We’re excited to help solve a problem that is only growing bigger. Financial losses due to fraud, waste and abuse are estimated at up to 10 percent of total annual healthcare expenditures in the U.S., more than $380 billion each year,” Ahmed said. “By making it easier for healthcare payers to stop fraud and claim billing errors before they happen, we’re closer to achieving our mission, which is to make healthcare more affordable and effective for everyone.”
