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Report: 100 Healthcare Execs Speak Out On Using AI To Curb Fraud, Waste And Abuse


In June of this year, a jury found a chiropractor guilty of defrauding health insurers out of $2.2 million by fraudulently billing for services that were never provided, and even went out of her way to issue bogus medical diagnoses, write false prescriptions and bill for fake office visits that never happened.

This is an example of cases that are causing a rise in concern for fraud, waste and abuse (FWA) schemes which are becoming rampant in the healthcare space and costing health insurers nearly 12 percent of their annual revenues, according to recent PYMNTS research. FWA is leading to significant problems that are plaguing claims management, payments and the overall cost of accessing healthcare.

Health insurers have a responsibility to their stakeholders, including both corporate employers and their employees, to prevent sharp increases in rates and other out-of-pocket expenses. Claims departments at insurance companies can find themselves playing whack-a-mole as new FWA schemes regularly continue to pop up.

As insurers are cognizant of the problem and are actively turning to solutions that can help them tackle FWA, however, PYMNTS’ research reveals that 44 percent of larger firms surveyed have already invested in artificial intelligence (AI) to combat FWA, while 71 percent […]

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