FIVE MINUTES WITH ...
BETH
GRIFFIN
MASTERCARD ' S VICE PRESIDENT FOR NEW SECURITY SERVICES IN HEALTHCARE AND CYBER & INTELLIGENCE , ON TACKLING FRAUD WITH ARTIFICIAL INTELLIGENCE
Q . WHAT ARE THE MOST COMMON TYPES OF FRAUD AFFECTING HEALTHCARE AT THE MOMENT ?
» Data breaches that often include personal health information are enabling bad actors to sell this valuable data at multiples much higher than even credit cards on the dark web .
There are also increasing fraud attempts targeting senior citizens via telemarketing since so many have been stuck at home during the pandemic . The bad actors call , posing as Medicare or other legitimate organisations , to obtain social security numbers , bank account information , or other personal health data in order to take out a loan , access a bank account or open an account . We also continue to see medical device fraud , pharmacy kickback schemes and other fraudulent activity by bad actors .
Q . WHAT ROLE DOES AI PLAY IN FIGHTING FRAUD ?
» Traditionally , members of a payer ’ s Special Investigative Unit ( SIU ) have manually reviewed claims to identify anomalies and created their own algorithms to identify fraud or rely on outdated rules . With Mastercard ’ s Brighterion AI , much of the intensive manual review can be eliminated by using risk scores and actionable rationale at both the provider and claim levels , which enable quicker and more accurate decisions . Further efficiencies come by stratifying the risk scores into different categories where the selection and investigation of certain providers and claims can be automated over time , creating additional time and efficiencies to focus on cases that matter .