An anti-fraud official from the Centers for Medicare and Medicaid Services said that artificial intelligence is enhancing her workforce’s capability to spot scams.
“There’s a lot of fraud in the healthcare sector. The estimates on the conservative side are about $100 billion and, depending on who else you talk to, you can easily double or triple that with different calculations,” said Jeneen Iwugo — the acting director for the CMS Center for Program Integrity — at the UiPath Public Sector Summit on Tuesday. “I have a modest budget of $1 billion, so the size of the problem is much bigger than the budget I’m given to find it.”
Specifically, Iwugo explained that AI tools are helping CPI’s roughly 500 employees better identify fraud across the four to five million claims they review every day.
“My team uses AI to comb through those claims and that data and figure out where the risk is the…
This involves defrauding the state or using government systems to steal from individuals.
- Tax Identity Theft: A criminal uses your ID and income details to file a tax return in your name and claim a refund before you do.
- Grant/Benefit Fraud: Falsely claiming unemployment, disability, or social grants that the perpetrator is not entitled to.