How Adopting AI Combats Fraud, Waste and Abuse Caused by Overpayment
Briana Contreras, an editor with Managed Healthcare Executive, had a chat with Clay Wilemon, CEO of 4L Data Intelligence, in this month’s episode of Tuning In to the C-Suite. The discussion was on the subject of fraud, waste, and abuse within the healthcare industry and how much of it stems from issues like overpayment. Clay addressed how the adoption of artificial intelligence can help combat fraud, waste and abuse and shared how much the industry can save by using AI.
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Contreras and Wilemon's discussion was on the subject of fraud, waste, and abuse within the healthcare industry and how much of it stems from issues like overpayment. Clay addressed how the adoption of artificial intelligence can help combat fraud, waste and abuse and shared how much the industry can save by using AI.
"You know, as a system, we are overpaying for healthcare in many cases, and that shows up as fraudulent activity, wasteful or abusive billing," Wilemon said in the conversation. "Why is it an issue now? Healthcare is a $4 trillion market in the United States. It's a lot of money. It's the biggest segment of our economy, and we're all dependent upon it. Costs just keep escalating."
It's estimated that fraud, waste and abuse is somewhere between the low end $250 billion a year and on the high-end estimates as much as $800 billion.
Wilemon added if we can eliminate that overpayment dynamic, then that makes healthcare more accessible and it reduces the cost to companies, to taxpayers, and to individuals who are seeking healthcare.
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