Medical insurance fraud unrelenting focus of feds, state bodies

The mantra “fraud, waste and abuse” is almost like the color red for Texas and national investigators focused on alleged fraud activities, especially in the white collar realm.

That world contains representative entries like Ponzi schemes, mortgage fraud, embezzlement and Internet scams.

And health care fraud. In fact, alleged medical-realm misbehavior almost stands out like Godzilla in the sights of state and federal regulators and law enforcers fixated on fraudulent wrongdoing.

We prominently note that on our website at the proven Houston criminal defense law firm of Hilder & Associates, PC. We stress therein that spotlighting health care fraud is “a high priority” for the federal government and state counterparts.

And its primacy in the fraud sphere is ever growing, with progressively more resources and increasingly sophisticated tools being employed to detect, deter and punish individuals accused of criminal conduct.

A recent Forbes piece underscores that, taking a particularly close look at the relatively new and constantly expanding role played by artificial intelligence in uncovering health care fraud. So-called “AI” is now supplementing in a major way the traditional fraud-detecting strategies based on “sifting through compliance and medical billing documents to determine what’s legit and what isn’t.”

We doubt that’s surprising to most of our readers, given technology’s evolving and dramatic inroads on public and private life these days.

Both fraudulently inclined parties and innocent wrongdoers in the workplace might well be affected by the ever-heightened capacity of new high-tech assets to closely investigate their conduct, though. Those tools render an already closely investigated realm even more susceptible to withering scrutiny.

We will take a closer look in our next blog post at how AI is being used to spotlight and thwart medical industry fraud.

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