HEALTHCARE FRAUD MITIGATION AND INVESTIGATIONS: IMPACT OF AI
R&C: Could you provide an overview of the scale of fraud in the healthcare sector? How would you describe the nature and scope of the problem?
Sikellis: Fraud in the healthcare industry is a major problem worldwide, resulting in the loss of billions of dollars annually. Estimates suggest that around $455bn of the $7.35 trillion spent on healthcare each year is lost to fraud and corruption – translating into as much as 10 percent of total healthcare expenditure in certain countries. While the secretive nature of fraud makes it difficult to determine its exact scale, it has wide-ranging consequences that include substandard or unnecessary procedures, counterfeit medications, delayed or denied treatments, compromised patient safety, increased costs and a profound loss of trust in the healthcare system. Additionally, fraud diverts resources away from legitimate healthcare needs, potentially compromising the quality of care. With the rise of digital healthcare systems, new methods of fraud are emerging, such as cyber fraud and data breaches. Therefore, remaining vigilant and staying ahead of potential risk areas is crucial for the industry.
Jul-Sep 2024 Issue
BDO USA, LLP
Novartis