The U.S. Department of Health and Human Services (HHS) is implementing advanced artificial intelligence (AI) tools to enhance the detection and prevention of Medicare and Medicaid fraud. This initiative is part of a broader crackdown on healthcare fraud, reflecting a shift from the traditional “pay and chase” model to a proactive “detect and deploy” approach. HHS is seeking stakeholder input for future regulations aimed at uncovering suspicious healthcare activities through the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative. While experts have praised the use of AI to combat fraud, they caution that safeguards must be in place to protect HIPAA-protected information. HHS plans to impose a six-month moratorium on certain Medicare enrollments and to investigate up to $1 billion in potentially fraudulent Medicaid claims in Minnesota. Effective oversight, transparency, and ethical AI use are critical to ensure that the tools accurately detect fraud without harming law-abiding healthcare providers and patients.
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