Pulling off health insurance fraud used to take time and skill.
Until a few years ago, criminals couldn’t fabricate health records without knowing medical terminology and billing codes.
If the scheme involved fooling a call center worker, the fraudster would have to pick up the phone and pose as a patient or doctor.
With artificial intelligence, these barriers have melted away. A simple prompt in a large language model like ChatGPT can generate documentation of a procedure that never happened. AI agents can be told to call an insurance company thousands of times in a single day without human involvement.
“We believed (AI) was something that was going to be leveraged against us as an insurance industry for fraud, and now we’re starting to see that,” said
Kurt Spear, vice president of financial investigation and provider review at Highmark.
The rapid proliferation of artificial…
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