Indiana FSSA to use AI to detect Medicaid fraud

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5 Comments

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  1. This may be one of the most illogical policy rationales I have read. Rather than focusing resources on identifying, auditing, and taking enforcement action against providers who submit fraudulent claims, Indiana has implemented—and continues to pursue—policies that are counterproductive and ultimately harm the very Medicaid members the program is intended to serve.

    Instead of addressing fraud directly, these policies introduce unnecessary uncertainty and administrative barriers that affect compliant providers and vulnerable beneficiaries alike. The result is a system that appears to shift the burden onto legitimate providers while allowing the State to avoid accountability for effectively identifying and addressing actual fraud.

  2. Can AI really do a worse job than this? “after an audit of 625 claims submitted to Medicaid identified errors in nearly all claims.

    Those alleged errors ranged from missing and incomplete consent forms and background checks, blank service plans, missing visit notes, billing for improper services and failure to activate electronic verification or providing services outside a patient’s location.”

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