Identifying healthcare fraud, waste and abuse is a highly evolved practice that is best done with a marriage of artificial intelligence (AI) and human intelligence (HI) capabilities. As the losses attributed to fraud continues to grow, unfortunately, we all share the responsibility of paying for it. The National Health Care Anti-Fraud Association (NHCAA) estimates that the financial losses due to health care fraud are in the tens of billions of dollars each year.1 The payment integrity review process of analyzing a healthcare claim can be strengthened by implementing a hybrid approach of both HI and AI. However, it's important to understand the benefits and limitations of each to avoid pitfalls that can arise. On July 20, 2022, the Department of Justice announced criminal charges against 36 defendants in 13 federal districts across the United States for more than $1.2 billion in alleged fraudulent telemedicine, cardiovascular and cancer genetic testing, and durable medical equipment (DME) schemes.

In 2020, an estimated £1.26 billion was lost to fraud in the UK. In the last 13 months, a staggering 449,687 incidents of fraud were reported to the National Fraud and Cyber Crime Reporting centre. It's clear that the domestic financial services industry has a huge problem -- and current strategies to mitigate it are not working. The financial industry in the UK has, like all industries, seen a huge acceleration in digital transformation over the past two years. The pandemic forcibly increased the pace of the transition to all manner of digital interactions, including online banking.

As the world's oldest and largest open-source intelligence agency, Jane's has spent the last 120 years collecting, classifying and analyzing information. We support national security analysts who are trying to understand the emerging threats to a country's national interest and how best to respond to them. Those analyst teams, our customers, could spend many weeks collecting the information, understanding it, verifying it, and then reporting on it. Or they can work with us to get highly accurate, relevant information from our open and classified sources. Then they can quickly get down to the business of reporting and providing decision-support to their agencies and governments.