Ricky Sluder is head of healthcare value engineering, North America, at Shift Technology. In this article, he addresses the ways in which health plans can use AI to spot fraudsters faster and more efficiently, while separating otherwise-well-meaning offenders from the the serious thieves.
Between 3% and 10% of total U.S. healthcare spending each year amounts to fraud, according to the National Healthcare Anti-Fraud Association. Facing potential multimillion-dollar losses, insurers invest significant resources into weeding out fraud and protecting their financial interests.
Conducting a healthcare fraud investigation is a laborious process that can take weeks at the minimum. Most of that time is spent sifting through information from multiple sources, piecing it together like a jigsaw puzzle to reveal a complete picture of the provider-member relationship. Only a small proportion is dedicated to actual decision-making.
But it doesn’t have to be that way.