AI prevents healthcare FWA and increases SIU efficiencies
Current estimates indicate that only 5-10 percent of healthcare FWA is intercepted. And investigators know that as quickly as SIUs uncover a new method of fraud, fraudsters have already moved on to their next scheme.
As healthcare fraud becomes increasingly complex SIUs are getting bogged down investigating false positives rather than dealing with actual criminal activity. AI-driven fraud prevention is a key technology for supporting investigators in reducing rules, boiling down hours of investigation into mere milliseconds and letting them focus on what they do best.
Veteran investigator Tim McBride, Director of Healthcare Product Development and Innovation, Mastercard, is a huge proponent of the power of AI to support SIUs in becoming tighter operations focused on complex fraud schemes and predictors of upcoming trends. In our new Ebook he shares the five ways that AI can supercharge your healthcare SIU as well as real-world examples of FWA cases and schemes and how AI could have combated them.
In this Ebook you’ll discover how AI can:
- Consolidate existing rules into one model resulting in less maintenance and higher efficiency
- Provide continuous learning which refines model for performance and accuracy
- Increase efficiencies and reducing false positives so that SIUs can focus on what really matters
- Detect fraud in real time before payments are made which offers 24/7 protection
- Create one-to-one data profiles for holistic detection