CMET438 Colorado State AI Applications to prevent Fraudulent Activity in Healthcare Paper

The Institute of Management Accountants Research Foundation issued a research report in 2014 on the current state of finance and accounting management in the healthcare industry. The report states that the compensation mechanism for healthcare providers (called a fee-for-service payment system) “creates an economic incentive to the provider to provide as many services to the patient as can be reasonably justified.” As a result, insurance companies are pushing back and denying claims, some of which were provided in good faith, due to billing or processing errors. Despite the ongoing efforts by insurers to “weed out” abusive practices in services and billing by providers, the United States Department of Justice estimates that healthcare fraud costs the United States billions of dollars annually (United States Department of Justice, Health Care Fraud Unit, n.d.).

When considering the technological capabilities of artificial intelligence and machine learning, research and report on two or more technology applications that are used or could be used to help insurers discover or prevent fraudulent activity in the healthcare industry. For example, an algorithm could be written to search many patient service claims to detect recurring billing patterns from a particular provider that could be indicative of fraud.

Your document should be 300-500 words and must have appropriate citations/references.

References

Institute of Management Accountants Research Foundation. (2014). The Current State of Finance and Accounting Management in the Healthcare Industry. Retrieved from https://www.imanet.org/insights-and-trends/externa…

United States Department of Justice, Health Care Fraud Unit. (n.d.) Facts & Statistics. Retrieved from https://www.justice.gov/criminal-fraud/facts-stati…

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