The National Healthcare Anti-Fraud Association estimates that health care fraud costs tens of billions of dollars every year. Health insurance special investigations units have long worked to stem the tide of losses, but it can be a challenge to stay ahead of the curve. To learn more about the tactics investigators employ and new tools at their disposal, SmartBrief spoke with Patrick Stamm, principal adviser to FraudScope, an AI-assisted platform for detecting health care fraud, waste and abuse. Please describe the existing health care FWA investigation paradigm and some ways in which it fails health plans? Historically, health care fraud investigations were almost exclusively initiated after the fact -- often as a result of a tip submitted to the special investigations unit from a member or employee who noticed something amiss while processing a claim.
Precision medicine and artificial intelligence (AI) are complicated by design: Both scientific fields rely on extreme specificity, complex equations, and forces that can't be seen. As both fields begin to alter the healthcare landscape, they could plant a number of legal landmines. Can algorithms or biomarkers be patented? Will centers be able to access the large data sets they need to perform accurate AI? What control over their data should patients have?
Health care providers enter into dozens of contracts with outside companies, like medical record disposal or storage entities, that have access to patients' medical information. Dan Mulholland, senior partner at the health law firm Horty Springer, said these contracts come and go so frequently that they're …
Today, we're pleased to announce the private preview of a new AI-powered project from Microsoft's Healthcare NExT initiative which is designed to enable our healthcare partners to easily create intelligent and compliant healthcare virtual assistants and chatbots. These bots are powered by cognitive services and enriched with authoritative medical content, allowing our partners to empower their customers with self-service access to health information, with the goal of improving outcomes and reducing costs. So, if you're using a health bot built by one of our partners as part of our project, you can interact in a personal way, typing or talking in natural language and receiving information to help answer your health-related questions.
Artificial intelligence or AI as it is called in cyber parlance, and believed to be the next big thing in information and technology, can play a key role in good governance, a senior Microsoft official has said. "We are seeing that governments are benefitting through Artificial Intelligence and are able to bring (governance) closer to people in their countries," Dave Forstrom, director of communications for the Artificial Intelligence (AI) group at Microsoft, told PTI. "Absolutely," he answered when asked if AI can be a tool in good governance. "In terms of helping create good governance we're seeing an approach industry--wide right now where it's focused on ethical design and those principles that will help to really govern that," he said on the sidelines of the Microsoft's annual developers conference Build 2017. Microsoft's India-born CEO Satya Nadella has identified AI as the center piece of the company's growth strategy. Forstrom said Microsoft is having partnerships with a number of governments in this regard.
President Trump suggested tonight that it's not fair to compare the Republican health care plan to the Affordable Care Act, because the law is "dying, dying, dying" and won't be around anyway. "They always like to compare -- well, what about [Obamacare]? Obamacare's dead," Trump said at a rally in Harrisburg, PA. "It's gone ... The insurance companies are fleeing." Between the lines: His comments suggested that he might try to use the law's problems -- including the steep premium hikes last year -- to dismiss the comparisons people are making to the GOP replacement plan, which aren't flattering. The biggest criticisms: it would cover 24 million fewer people than the ACA, and under some of the latest changes, it might not give the same protections to people with pre-existing conditions.
A new website that predicts congressional bills' success foresaw the Affordable Care Act replacement bill would be shelved instead of passed – awarding it only a 15 percent chance of being enacted. Users can look up any pending bill on PredictGov or find predictions through its partner, legislation tracker GovTrack, which now includes a "prognosis" line in its overview of each bill. Vanderbilt University law Professor J.B. Ruhl is a co-founder in bill forecasting site PredictGov. PredictGov, which uses big data and artificial intelligence to reach its conclusions, is the invention of Vanderbilt University law Professor J.B. Ruhl; computer scientist and doctoral candidate John Nay, and their team. It pulls from decades of congressional data plus hundreds of variables, including the bill's sponsor, amendments, economic trends and political shifts.