How AI fights fraud to enhance healthcare delivery

Federal health agencies like the Centers for Medicare and Medicaid Services (CMS) and the Veterans Health Administration (VHA) are attractive targets for scammers, largely due to volume and complexity. Volume of claims processed and paid, volume of patient and provider records, and complexity of healthcare programs, benefits and policies. The result is an ecosystem rife with opportunities for fraud, whether via identity theft, false claims or other constantly evolving attacks.

“Bad actors are always finding new approaches as new services are approved, or new policies come out,” said Karen Painter, senior program director for fraud, waste and abuse at General Dynamics Information Technology (GDIT). “We see a lot of adaptation among the bad actors in how they're targeting the programs.”