The majority of health insurers’ fraud, waste and abuse (FWA) investigations take place after claims are paid, not before — and consumer payments can be a particular point of vulnerability.
Artificial intelligence (AI) can help healthcare companies tackle those vulnerabilities and battle the fraudsters, as PYMNTS found in the latest “AI in Focus: The Healthcare Technology Roadmap” report, done in collaboration between PYMNTS and Brighterion.
Read more: AI in Focus: The Healthcare Technology Roadmap
Of the 100 healthcare executives surveyed, 71% plan to invest in AI technologies over the next three years to aid them in their efforts to combat FWA. One-hundred percent of those with more than $1 billion in annual revenues plan to invest in the technology, as do 89% of those with annual revenues between $100 million and $1 billion.
The technology can help sift through large volumes of provider and customer payment-related data in real time, flagging potentially risky claims long before they are paid.
About 95% of the firms surveyed said the technology has a high degree of accuracy in detecting FWA. As many as 97% of respondents said it is very or extremely important for an AI tool to adapt to changing behaviors evident in claims data.
Read more: AI in Focus: The Healthcare Technology Roadmap
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