using AI to detect fraud and improper payments

Detecting fraud and improper payments.

The Centers for Medicare and Medicaid Services (CMS) uses statistical analysis to identify fraudulent and improper payments made to healthcare providers. In 2018, 8.12 percent of all Medicare payments were improper, according to CMS. In order to address this problem, CMS employs a testing methodology called Comprehensive Error Rate Testing (CERT). They also use AI to engage in predictive analysis of fraudulent and improper healthcare payments. This process has saved the government approximately $42 billion, according to CMS.