Artificial intelligence could help halt health insurance fraud

Artificial intelligence applied by health insurers could help save millions of dirhams a year in fraud and abuse within the UAE healthcare system, analysts claim. Swiss software company Netcetera has completed a successful trial of its latest technology within a major health insurer, spotting almost 37,000 suspicious claims made by more than 4,000 doctors between 2016-17. Those bogus claims totalled Dh21 million and would usually have gone unnoticed by insurers, who would end up paying out for unnecessary treatments given by hospitals and clinics. The system developed by Netcetera uses an AI model that runs an algorithm to detect a pattern of behaviour. The AI model built into an insurers claim system will recognise a usual pattern of prescriptions and raise a red flag when a doctor delivers an abnormal course of treatment.