Bringing AI To The Fight Against Healthcare Payments Fraud

The coronavirus pandemic
poses an unprecedented challenge to healthcare systems that will
likely extend for months — and perhaps even years — to come.
More than ever, hospitals and other medical facilities need to
focus their resources on healing the sick and avoid getting bogged
down by administrative costs and inefficiencies.

This brings a longstanding challenge to the fore: Healthcare
organizations have long struggled with fraud,
waste and abuse
 (FWA), costing the United States healthcare
sector more than $200 billion annually by some estimates. This
reflects the complexities of a payment chain in healthcare that
involves multiple entities, including patients, insurers, providers
and government agencies.

In many realms of businesses, machine learning (ML) and
artificial intelligence (AI) have yielded powerful tools to manage
such complex matters. Yet, these advanced computational systems
have a long way to go in healthcare administration. Just 4.3
percent of organizations in this sector currently use AI, according
to PYMNTS’ latest research. In contrast, nearly 10 percent of
financial institutions (FIs) use these systems.

Read more here

Posted on April 10, 2020