Author:Kirsten Brueggemann
AI Nancy Drew, Is That You?
The United States spends more money per person on health care than any other country, approximately $4.2 trillion in 2021. Unfortunately, our complex health care system and the large budget make fraud a significant concern for the U.S. Government, payers, and patients. The National Healthcare Anti-Fraud Association estimates that as much as 10% of annual healthcare spending is lost to scams, resulting in billions in losses yearly. To combat healthcare fraud, the Department of Health and Human Services Office of the Inspector General, in collaboration with state law enforcement and other governmental agencies has created special Strike Forces. These efforts have led to substantial recoveries of federal funds and criminal/civil prosecution of individuals or entities involved in Medicare and Medicaid fraud. Besides avoiding unnecessary or fraudulent claims, individual healthcare payers are motivated to prevent fraud due to severe penalties associated with the False Claims Act, Anti-Kickback Statute, Physician Self-Referral Law (Stark Law), and Civil Monetary Penalties Law. How can individual payers detect and try to prevent fraud? The answer is AI.
Healthcare’s Red and Blue Pill: AI
Artificial Intelligence (AI) has gained widespread attention, often perceived as a buzzword. Recently, concerns about its potential dangers and issues with plagiarism have surfaced. However, AI holds immense promise for transforming industries reliant on data analysis and predictive algorithms, especially in healthcare. AI can significantly improve healthcare by aiding in diagnosis, optimizing patient outcomes, reducing costs, and saving time.
Ethics for the Supremes
Shortly before the conclusion of the Supreme Court’s term in June 2023, the Court delivered three blows to President Biden and Democratic party. First, the Court struck down the student debt relief program championed by President Biden. Second, the Court ruled in favor of a Colorado web designer who sought the right to refuse service to a same-sex couple. Lastly, the Court gutted affirmative action by making it unlawful for colleges to consider race as a specific factor in admissions. These high-profile decisions came just over a year after the contentious Dobbs decision, following an extraordinary leak, which overturned abortion rights that had been established under Roe v. Wade and Planned Parenthood v. Casey. These cases are perhaps marred by recent ethics scandals amongst the justices. Consequently, voices from both sides of the political aisle have called for reform of the nation’s highest court.