The Centers for Medicare and Medicaid Services has been able to save billions of dollars in less than a year by applying artificial intelligence to tackle duplicative contracts and fraudulent claims, according to Kim Brandt, deputy administrator and chief operating officer at CMS, who spoke at the Nextgov/FCW Fed Tech Priorities summit on Feb. 18.
She described the AI system as “a Netflix-type algorithm” that can pinpoint bad actors by using existing information to label an applicant as potentially “high risk” when submitting claims. Brandt clarified that the AI does not allow CMS to prohibit applicants from entering CMS programs, but instead allows them to be placed on an internal watch list for ongoing monitoring.
“Within the first year [of using AI], to be able to get rid of 90% of some of these potentially bad actors, it’s a huge thing for us,” Brandt said.
AI has been a welcome…
PROCUREMENT & EXPENDITURE (STOPPING KICKBACKS)
Procurement fraud usually involves inflated invoices or “fictitious” vendors.
- The Three-Way Match: Never pay an invoice unless you have matched the Purchase Order (PO), the Delivery Note (signed), and the Supplier Invoice.
- Vendor Master File Review: Review your vendor list annually. Look for suppliers with the same bank details or physical addresses as your employees.
- Dual Authorization: Implement a “Two-to-Sign” rule for all EFT payments above a certain threshold (e.g., R5,000).
- No “Cashing” of Checks: If you still use physical checks, strictly prohibit “Cash” as a payee and store blank checks in a dual-lock safe.