New publication outlines opportunities for accelerating and improving the use of AI to support payment integrity and reduce fraud, waste, and abuse
Last week, HL7 International released a new report outlining the actions needed to fully realize the benefits of artificial intelligence (AI) in improving payment integrity and reducing fraud, waste, and abuse. Reducing Fraud and Improving Payment Integrity in Healthcare Through the Use of AI brings together insights from payers, providers, and technology experts to define AI opportunities and emerging solutions, current challenges, implementation strategies, and standards needed to increase transparency and trust.
“The U.S. spends more than $900 billion annually on administrative complexity, waste, and improper payments,” said Charles Jaffe, MD, PhD, CEO of HL7 International. “This publication identifies practical and standards-based approaches to harnessing AI for one of healthcare’s most persistent and costly challenges.”
Key recommendations from the report include:
- Developing standards for explainable AI in healthcare with specific transparency requirements and bias mitigation protocols.
- Creating standards and infrastructure for trust and verification of AI-generated results.
- Establishing frameworks for human-in-the-loop validation that balance automation with clinical expertise.
- Implementing pilot programs focused on provider-payer collaboration that create mutually beneficial scenarios for all stakeholders.