How AI Can Battle A Beast--Medical Insurance Fraud


What if the patient was given a test, but it was actually a less expensive version than what the hospital billed for? Finding the answers to these kinds of questions can involve gathering and analyzing massive amounts of data from myriad sources. Traditionally, human fraud examiners have taken on these tasks, as they specialize in sifting through healthcare compliance and medical billing documents to determine what's legit and what isn't. Healthcare is built around helping people stay well or recover following illnesses and injuries, but like other industries it is susceptible to a range of fraud that can cause financial harm and drive up costs in the system. "Fraud, waste, and abuse is a huge contributor to unnecessary costs and the rise of spend within healthcare in the U.S.," says Arielle Trzcinski, senior analyst at Forrester.