💵 The $309 Billion Problem

Good morning! 

Welcome to Healthcare AI News, your weekly dose of the latest developments and headlines in the world of healthcare AI.

This week, we're exploring the power of AI to detect insurance fraud. We also look at voice technologies in healthcare, changes coming as pandemic emergencies expire, and is the gap between AI and Blockchain getting closer?

Be sure to read on to see this week's Top headlines, Industry, Tech, and M&A news. 

Let's dive in.

HEADLINE ROUNDUP

• What is BioGPT and what does it mean for healthcare? (Read more)

• Researchers use artificial intelligence to predict suicide risk. (Read more)

• How AI is transforming employee wellness benefits. (Read more)

• The future of voice technologies in healthcare. (Read more)

• Philips and AWS automate PHI de-identification with machine learning (Read more)

• New AI-Powered products from Experian Health will help healthcare providers recoup the billions in lost dollars (Read more)

• Researchers identify social predictors of premature death risk for seniors leveraging machine-learning approaches. (Read more)

• Cognetivity Neurosciences releases latest version of AI-powered brain health assessment platform. (Read more)

• Albertsons Companies launches Sincerely Health digital health and wellness platform. (Read more)

• How hyper-automation transforms retail healthcare for better patient experience. (Read more)

💡 Keep reading to catchup on Industry, Tech & Deal flow

THE FEATURE

Can AI Detect Health Insurance Fraud?

Health insurance fraud is a major issue in the healthcare industry, costing $309 billions a year or nearly $1,000 for every American. Conventional fraud detection methods, such as manual review, are often slow and inefficient. However, the advent of artificial intelligence (AI) offers a promising solution for detecting fraud and improving the accuracy of fraud detection. 

🛣️ The landscape

With the ability to analyze vast amounts of data, AI algorithms can quickly identify patterns and anomalies that are indicative of fraudulent behavior, which could otherwise go unnoticed by human investigators. These patterns could include multiple submissions for the same service, claims for services that were not performed, or suspicious changes in the types of services being claimed. 

According to a recent Accenture study, AI-driven fraud detection has the potential to save the insurance industry billions of dollars and revolutionize the way that health insurance fraud is detected and prevented by constantly monitoring claims and policyholders, flagging potential fraud, and providing real-time alerts for further investigation.

 💻 The disruptors

• RAAPID is an NLP platform that processes raw patient data from multiple sources and transforms it into a usable form. It helps identify risk, improve care quality, close gaps, and optimize financial performance. The solutions offered by RAAPID have resulted in an additional 11 percent to 15 percent increase in suspected but unreported conditions captured.

• ClaimDirectorSM is another platform that utilizes the power of predictive analytics to score claims with greater accuracy. This platform leverages machine learning, extensive data sets, and predictive models to score claims and detect potential fraud. Insurance companies using predictive analysis, such as ClaimDirectorSM, have reported a 67% reduction in expenses and a 60% increase in sales.

• Change Healthcare is another company that utilizes AI-driven solutions for fraud detection and prevention in the healthcare industry. Their platform uses machine learning algorithms to analyze large amounts of data and identify patterns indicative of fraud, waste, and abuse. The clinical connectivity solutions offered by Change Healthcare touch 1 in 3 US patient records.

• H2O.ai is an AI platform that provides fraud detection solutions for the healthcare industry. Their platform uses machine learning algorithms to analyze claims data, identify potential fraud in real-time, and assist with underwriting. Currently, 20,000 global organizations use H2O.ai in some capacity.

📣 Success Stories: 

Highmark Inc.'s Financial Investigations and Provider Review (FIPR) department made a financial impact of over $260 million in savings related to fraud, waste, and abuse in 2019. FIPR successfully uses AI to enhance the company's ability to identify, prevent, and stop potentially fraudulent activities.

Although AI offers promising potential for detecting health insurance fraud, its implementation must be cautiously approached. The accuracy of AI algorithms is directly tied to the training data quality and the algorithms' refinement. False positive results can still occur, and it is important to have proper systems in place to review and validate the results. In addition, the transparency and accountability of AI systems must be a priority to ensure that the decision-making processes are fair and unbiased and that any potential biases can be identified and corrected. In order to reap the full benefits of AI in detecting health insurance fraud, it is essential to implement these technologies responsibly and ethically, balancing the advantages of improved accuracy and efficiency with the need for transparency and accountability.

INDUSTRY NEWS

• Big changes are coming to U.S. health care as pandemic emergencies expire. (Read more)

• Kaiser’s $4.5B loss in 2022 driven by labor expenses, investment losses. (Read more)

• Lawmakers, labor unions negotiating single-payer health care bill. (Read more)

• Cigna evolves brands to reflect growing portfolio. (Read more)

• UnitedHealthcare launches rewards program with focus on wearables. (Read more)

• Biden-Harris administration continues unprecedented efforts to increase transparency of nursing home ownership. (Read more)

• Prealize Health releases new report on Social Determinants of Health (SDoH), showing extensive role non-clinical risk factors play in overall health. (Read more)

• Streamlining interstate access to gender-affirming surgeries. (Read more)

• Healthcare moves: a monthly summary of hires and layoffs. (Read more)

TECH NEWS

• Google issues warning about AI-generated content about health and finance. (Read more)

• Mining EHR data to understand documentation burnout. (Read more)

• GitHub’s Copilot for Business is now generally available (Read more)

• The gap between AI and blockchain has finally been bridged with the arrival of OxAI. (Read more)

• WebPT launches industry leading enterprise capabilities for Information Security and Data Availability (Read more)

• Golang Vs Python: Which language do you need to learn in 2023? (Read more)

• Siemens issues first digital bond on blockchain (Read more)

• Why you shouldn’t trust AI search engines. (Read more)

DEAL FLOW

• Elevance Health Announces Closing of BioPlus Acquisition. (Read more)

• Amgen plans mega bond deal to help fund $28 billion Horizon Therapeutics acquisition (Read more)

• GE HealthCare to acquire Caption Health, expanding ultrasound to support new users through FDA-cleared, AI-powered image guidance. (Read more)

• Sanford Health, Fairview Health Services delay merger until May. (Read more)

• With Humira under pressure AbbVie puts bigger M&A deals back on the table. (Read more)

• Abbott to acquire Cardiovascular Systems Inc. (Read more)

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TOP 3 TWEETS OF THE WEEK