How Generative AI Helps with Fraud Prevention in Healthcare
Healthcare fraud is a pervasive problem that costs individuals and insurance companies billions of dollars each year. According to the National Health Care Anti-Fraud Association, over $54 billion is lost annually due to fraudulent and illegal medical charges. As the volume and complexity of healthcare data continue to grow, traditional fraud detection methods are struggling to keep pace. This is where generative AI-powered fraud detection can make a significant difference. In this blog, we will discuss five ways in which generative AI helps with fraud detection in healthcare. Applications of Gen AI in preventing healthcare fraud 1. Automated Detection of Unusual Billing Patterns Generative AI in healthcare can analyze large datasets to spot unusual billing patterns that may indicate fraudulent activities. By continuously learning from historical data, AI models can identify discrepancies such as overbilling, upcoding, or billing for never-rendered services. Here’s an example to help