Tuesday, August 31, 2021

Michigan Dentist Charged for Fraud

 If true, this is a bit of a sad story, but it also has a bit of a techy slant...

A Lansing, Michigan dentist has been charged with 10 counts of defrauding Medicaid.  To be specific, the Michigan Healthy Kids Dental program.  I'm not mentioning names here because "innocent until proven guilty", but this story did get me to thinking about this situation.

Over the years there have been numerous stories of physicians and dentists that have fraudulently billed Medicaid programs for services they did not perform.  Just do a Google search on "Medicaid Fraud" and see how many different cases are identified.

The tech side of this is in the world of Artificial Intelligence and Machine Learning.  I've seen some interesting ideas bantered about regarding using these types of systems to search billing records to look for suspicious patterns that might require closer scrutiny.

Those types of systemic abuses have been happening probably as long as there have been public funds paying for goods and services.  The thing is, those abuses plunder funds needed to help those less fortunate receive care.

I feel in the past the reason these types of cases occur is that it is simply too easy and tempting.  Most reimbursement with public funds are very low from a compensation standpoint and even though it's morally and ethically wrong, people can convince themselves that it is only a few dollars and that it just offsets the lower reimbursements.  But it doesn't matter how you justify it, perpetrating fraud is wrong and illegal while also depriving needed funds from others.

While AI may not be the final answer to solving these types of problems, if it can help authorities find and eliminate these types of fraud cases, maybe it will help keep the money available for those who are in need of those services.

No comments:

Post a Comment