AI in Healthcare Fraud Detection: Safeguarding Against Financial Crimes

Abstract

The health care sector standing as one of the largest industries in the global economy is becoming vulnerable to fraud, billing fraud, insurance fraud and identity theft. In an endeavour to reduce such risks AI technologies especially the ML algorithms are being used to identify fraudulent claims within the healthcare systems. The capability of AI in processing of data sets and interpretation of undiscoverable patterns to human beings presents a lot of benefits that can be harnessed in improving the efficiency of the detection of frauds in an organization. In this paper, the methods applied to conduct healthcare fraud with the help of AI technologies are analysed, the efficiency of their application is discussed, the threats and opportunities inherent in their implementation are identified together with ethical considerations to take into account. The implications of employing artificial intelligence in preparing the healthcare sector for future frauds will also be discussed with details of how machine learning algorithms, data and analytics, and predictive models and modelling are emerging as core tenets for protecting the industry against financial crimes.