The Trump administration expands its use of AI in the hunt for healthcare fraud
The program will analyze at least five years of audits and could withhold funds from recipients that fail to fix problems, officials said.
- On Thursday, the U.S. Department of Health and Human Services announced an artificial intelligence initiative to audit how states and federal health program recipients manage taxpayer dollars, with Assistant Secretary for Financial Resources Gustav Chiarello confirming notifications were sent to all 50 states.
- The agency aims to replace the legacy "pay and chase" model with real-time claim screening to address improper payments totaling $28.83bn in Medicare fee-for-service and $23.67bn in Medicare Part C during fiscal 2025.
- Officials are developing a planned rule called "Comprehensive Regulations to Uncover Suspicious Healthcare," or CRUSH, to analyze audits for entities spending at least $1 million annually and identify billing patterns statistically associated with fraud.
- Letters sent to governors and treasurers warn that HHS will no longer tolerate chronic audit noncompliance or delinquent obligations, with recipients facing potential loss of federal funding if they fail to resolve deficiencies.
- Public Citizen co-president Rob Weissman and other critics warn that AI tools may introduce bias or errors when flagging claims, citing the administration's prior admission of data mistakes during a New York Medicaid investigation.
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The Trump administration expands its use of AI in the hunt for healthcare fraud - The Boston Globe
The U.S. Department of Health and Human Services on Thursday announced it is supercharging its use of artificial intelligence to police how states and other recipients of federal health dollars are auditing their programs. The move is intended to tamp down risks of fraud and save the government money.
Trump Admin Expands Its Use of AI in Hunt for Healthcare Fraud
(MedPage Today) -- HHS on Thursday announced it is supercharging its use of artificial intelligence to police how states and other recipients of federal health dollars are auditing their programs. The move is intended to tamp down risks of fraud...
Associated Press News
The Trump administration expands its use of AI in the hunt for healthcare fraud
The Department of Health and Human Services is boosting its use of artificial intelligence to monitor audits from federal grant recipients.
HHS launches AI initiative to detect fraud and waste in federal health programmes
The Department of Health and Human Services is moving from “pay and chase” to real-time AI screening across Medicare, Medicaid, CHIP and the Marketplace. The US Department of Health and Human Services has launched an artificial intelligence initiative aimed at detecting fraud and waste across federal health programmes, building on a strategy first outlined in […] This story continues at The Next Web
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