Proposes the use of an insurance industry-wide AI database for detecting insurance fraud. Discusses benefits and obstacles to such an AI database’s creation and use. Presents example of its utility in uncovering concealment and fraud.
Case studies highlight how well-trained claims personnel and vigilant discovery during litigation can help combat organized prescription medication fraud
Anyone who has spent time reviewing claim forms and bills submitted by medical providers has probably encountered at least some of the more typical fraud schemes: overbilling, false claims, or maybe even kickbacks and bribery. Sophisticated technology, investigative techniques, and data analytics let us zoom in – and out – to identify these traditional forms of fraud at the individual claim level and on a system-wide scale.
But a recent opinion by the New York Court of Appeals, the state’s highest court, should serve as a reminder to look out for a different sort of fraud that ...
