Data & Analytics: Healthcare Fraud Detection
Description
DEA needs a way to facilitate analysis of health care fraud and abuse, especially those impacting government health programs. Federal government healthcare insurance programs include Medicare, Medicaid, TRICARE, VA, and others. The Health Care Fraud and Abuse Control Program (HCFAC) was created to unite DOJ and HHS in their efforts to combat fraud.
Detailed example
Outputs include data visualizations, as well as trend, benchmark, and link analyses.
AI / analytics pattern
Generative AI: AI that generates new or synthetic content (e.g., images, videos, audio, text, code).
Automation level / stage
c) Deployed – The use case is being actively authorized or utilized to support the functions or mission of an agency.
Expected benefit
Enhances the detection and prevention of health care fraud and abuse crimes within the context of DEA's mission.
Controls / human review
ATO: No; PIA: Not published
Data needed
The case owner relied on DOJ AI governance practices to select and prepare data, as well as evaluate performance.