Can AI Solve Health Insurance Fraud? - Insurance Thought Leadership

An AI technique called group analysis, used to detect e-commerce fraud, holds great promise for catching fraud rings sooner rather than later. Insurance fraud scams seem to make the news at least every month, as organized criminals seek to exploit the way insurers reimburse clinics, pharmacies and other providers for their services. What's often shocking is how much money fraudsters can steal from insurers before they're caught. Recently, in a single month, two separate alleged fraud rings based in California were busted for scams that investigators say netted $20 million or more. Clearly, there's a need for fraud detection tools that can spot these frauds in their early stages.