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…
Cyber fraud uses technology as the primary weapon. It is highly scalable and can be conducted from anywhere in the world.
- Phishing/Smishing/Vishing: Using deceptive emails (phishing), text messages (smishing), or phone calls (vishing) to trick victims into clicking malicious links or revealing sensitive data.
- Business Email Compromise (BEC): A high-value scam where a criminal impersonates a CEO or high-level executive via a “spoofed” email address to trick a staff member into making an urgent, unauthorized wire transfer.