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Caffery, Oubre, Campbell & Garrison, L.L.P.
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A look at AI’s increasing role in spotlighting medical fraud

A recent Forbes article on a distinct challenge to insurers from the medical realm underscores that the industry “is susceptible to a range of fraud that can cause financial harm and drive up costs in the system.”

That is perhaps the most underwhelming statement readers of our Louisiana insurance defense blog will encounter all day. In fact, the sheer dimensions of fraud in the health care industry have long been known across the country, and they are staggeringly huge. The FBI estimates that the price tag for such wrongdoing costs the public scores of billions of dollars annually. Criminal investigators, regulators and, of course, insurers are painstakingly focused on the hard task of identifying, deterring and punishing medical fraud.

And they need help.

Reportedly, it has arrived, and in a manner that is having an appreciable effect on the bottom line. The new kid in town is the powerful assist provided to human investigators by so-called “AI” tools. Commentators say that tailored artificial intelligence software and systems are proving tremendously useful for their utility to help sift through and make sense of massive amounts of data that are relevant to fraudulent behavior.

Humans can do that, but at an infinitely slower pace and less accurately. The Forbes piece notes that AI can better detect fraud before it even begins. Tweaked artificial intelligence tools can also “effectively build a body of evidence” to provide investigators and insurers with when they are trying to build a case concerning already existing misbehavior.

We’ll take a closer look at AI applications and utility in fraud fighting in our next blog post.

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