Artificial Intelligence Holds Promise in Detecting Home Health Medicare Fraud

A study on artificial intelligence (AI) suggests the technology holds promise for detecting Medicare fraud within home health and hospice. However, leaders within the industry say a measured approach should be taken, given potential shortcomings and pitfalls related to AI. The research team at Florida Atlantic University programmed computers to predict, classify and flag potentially fraudulent Medicare Part B claims from 2012 to 2015. Fraudulent activities included patient abuse or neglect and billing for services that weren't delivered. The team applied algorithms to detect patterns of fraud in the Centers for Medicare & Medicaid Services (CMS) data because "patterns in the data are hidden from us" as humans, said Taghi Khoshgoftaar, Florida Atlantic University director of Data Mining and Machine Learning Lab in the Department of Computer and Electrical Engineering and Computer Science.