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.
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.
Conversations With Perry and Friends
April 14th 2025Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, is host of the Conversations with Perry and Friends podcast. His guest this episode is John Baackes, the former CEO of L.A. Care Health Plan.
Listen
Ohio’s Medicaid Work Requirement Efforts Aim to Boost Engagement, Avoid Coverage Loss
April 18th 2025Maureen Corcoran, director of the Ohio Department of Medicaid, believes the work requirement policy can be both a financial and moral effort to improve the lives of Medicaid consumers.
Read More
Breaking Down Health Plans, HSAs, AI With Paul Fronstin of EBRI
November 19th 2024Featured in this latest episode of Tuning In to the C-Suite podcast is Paul Fronstin, director of health benefits research at EBRI, who shed light on the evolving landscape of health benefits with editors of Managed Healthcare Executive.
Listen
Why Better Data and Awareness Matters for Medicaid Work Requirements
April 17th 2025With policymakers considering work requirements for Medicaid eligibility, Jennifer Haley, principal research associate in the Health Policy Division at the Urban Institute, said it’s more important than ever to understand how those changes could unintentionally cause harm, particularly when data systems fall short and public awareness is limited.
Read More