AI: Finding the Fraud Needle in the Big Data Haystack

A systematic AI approach used against fraud, waste, and abuse not only uncovers specific instances, but often provides additional insights.

With fraud losses accounting for about 3% of the nation’s overall health care spending each year, pharmacy benefit management firms would be wise to seize the opportunity to battle endemic fraud, waste, and abuse (FWA). The upside can be significant, according to the National Health Care Anti-Fraud Association, which estimates annual losses at $68 billion nationally.