Over the last year, generative AI has captivated the public imagination. Many of us have become newly acquainted with the concept of an approaching Singularity coined by John von Neumann or Nick Bostrom’s Paper Clip thought experiment. Fortunately, Microsoft’s office assistant, Clippy, has yet to dutifully transform our planet into
Prepare for the best – and the worst – when it comes to generative AI and health care fraud.
See how analytics fights back against ever-changing fraud trends.
Ladies and gentlemen, I give you Value-Based Payments (VBP), health care’s new magic, “silver bullet” that will solve all our fraud problems. Last month, the US Department of Health and Human Services (HHS) issued a press release entitled, “HHS Proposes Stark Law and Anti-Kickback Statute Reforms to Support Value-Based and
Artificial intelligence often seems misunderstood, especially in fraud. The same is true of machine learning. One of the amazing things about them is they ask the unasked questions. This occurs as artificial intelligence (AI) and machine learning (ML) go about their daily work. So, what is the unasked question? Too
Blockchain technology and payment integrity in health care Blockchain technology has arrived in the health care space, bringing anticipation of revolutionary change in operational efficiency, data management, security, fraud prevention, disease prevention, and perhaps even in payments. While these are not new goals, I am ever the optimist. As almost
International Fraud Awareness Week is here! I know, I know… Fraud Week is not quite as exciting as Shark Week. It doesn’t appeal to your taste buds like Restaurant Week. Nor does it have the quirky feel of Brain Awareness Week (nope… I’m not making that one up!!). Nevertheless, Fraud Week is
On June 22nd, the U.S. Department of Justice announced the largest Medicaid fraud bust in history. The National Health Care Fraud Takedown included 301 defendants charged, $900 million in false billings, 61 medical professionals and 29 doctors, across 36 states. In another case, investigators in New York uncovered more than
To prepare for the data challenges of 2015 and beyond, health care fraud, waste and abuse investigative units (government funded and commercial insurance plans, alike) need a data management infrastructure that provides access to data across programs, products and channels. This goes well beyond sorting and filtering small sets of
According to Time Magazine, the next Ebola outbreak will cost the World Bank in excess of $30 billion dollars. In 2014, America spent in excess of $1.16 million dollars to treat two victims of the dreaded disease. While Ebola and other microorganisms of the deadly variety are scary creatures there
Every day there are news stories of fraud perpetrated against federal government programs. Topping the list are Medicaid and Medicare schemes which costs taxpayers an estimated $100 billion a year. Fraud also is rampant in other important federal programs, including unemployment and disability benefits, health care, food stamps, tax collection,
On a cold and wet December morning in 2008, at approximately 1:30 AM, I pulled into the parking lot of an abandoned supermarket in Arlington, TX. With sleet pelleting my windshield, I saw three additional sets of headlights enter into the parking lot from different directions. All three cars converged
For most people, this time of year means celebrating cherished, personal traditions… helping those less fortunate…flocking to stores in droves…the company holiday party… For the SAS Security Intelligence team, it means identity theft…benefits fraud…unemployment insurance fraud...insider threats. Why? Because next week is International Fraud Awareness Week! And we’re celebrating by
