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AI tools increasingly at the fore in medical fraud probes

We noted what is almost a truism in the criminal law realm these days in our immediately preceding blog post, namely, that health care fraud is a top-tier agenda item. We stated in our Hilder & Associates February 19 entry that it “stands out like Godzilla in the sights of state and federal regulators and law enforcers.”

That heightened scrutiny obviously has dramatic implications for individuals and corporate entities accused of fraud-linked misbehavior. In fact, high numbers of medical industry participants (doctors, nurses, lab techs, sales reps, billers and more) routinely face criminal charges filed by Texas and/or federal officials.

What has become especially notable these days in the medical fraud universe is the growing reliance of investigators on what we noted in our previous post are “increasingly sophisticated tools” for detecting fraud. So-called “AI” assists based on hyper-complex algorithms and related software are being progressively employed in investigations across the country. Artificial intelligence has rapidly become a default decider in how probes spot and deter fraud, and how authorities take criminal action against alleged wrongdoers.

A recent Forbes article spotlights the growing role of artificial intelligence in health care fraud investigations. It notes that AI supplements human examiners’ efforts through a singular ability tied to “gathering and analyzing massive amounts of data from myriad sources.” High-tech tools not only seek to uncover patterns that reveal existing misconduct, but also target behavioral data aimed at actually detecting fraud that might occur.

Those stressed abilities are obviously exciting to law enforcers and regulators, but understandably a bit scary to much of the general public.

Stories from the world of medical fraud reveal that all manner of individuals are ensnared in investigative nets. That is, innocent employees as well as purposeful wrongdoers are sometimes targeted in probes mistakenly or for conduct they never imagined was unlawful.

Health care fraud is a highly complex and heavily scrutinized realm. Persons with questions or concerns regarding any aspect of this legal sphere can contact a proven fraud-defense law firm for counsel and diligent representation.

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