Preventing Healthcare Fraud with AI and Machine Learning

Preventing Healthcare Fraud with AI and Machine Learning

By Healthcare Tech Outlook | Monday, December 10, 2018

Healthcare fraud is rapidly increasing in today’s world. Fraud acts as a plague on the healthcare system that drains the system financially and endangering the security and health of the consumers. Healthcare fraud is expensive and growing expensive each year. The National Healthcare Anti-Fraud Association estimates fraud costs Americans $42 billion annually.

The healthcare fraud issues take place through medical billing and coding, causing major legal and financial issues for healthcare facilities. Few errors are unintentional, but companies and individuals are still investigating those errors regardless of intention. AI software could also help prevent such type of errors.

AI and machine learning in healthcare can help to prevent the losses from healthcare fraud. Here, AI emulates the human being who is evaluating the claim and other fraudulent activities in healthcare and behaves like an individual. AI is programmed in a specific method where it can detect the abnormalities in the payment integrity. Fraudulent activity detection by AI is reliable and consistent. Machine learning understands the programs by analyzing data and drawing patterns according to the various responses of new payment integrity controls. The combination of AI and machine learning acts as the analytical decision-making system for the integrity of healthcare payments.

It is necessary to implement AI and machine learning in accordance with the proper payment integrity strategy that satisfies the needs of the organization. Also, connecting with organization partners expands the payment integrity results. AI and machine learning can help businesses stay aware of the problem makers by noticing changes in the claim and responding accordingly.

 AI can detect errors in coding across a variety of treatments and specialties consistently. AI software is much more flexible because it can be programmed in a way that almost anything users need to predict or detect can be identified. It has the ability to create an efficient and accurate claims process for medical facilities. Implementing AI systems help save money, time, and resources needed to prevent fraud.

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