Enhancing General Practices (GPs) and Clinical Operations and Fraud Detection with Al

Implementation Time:
24 months
Solution Provider: AI Singapore

MHC Asia Group is Singapore’s leading health technology company specialising in medical benefits administration for employees since 1994.

  • Healthcare cost is at an escalating trend, evermore so now than ever before. There is currently a lack of transparency in the healthcare system
  • Up until now, there are no accurate ways to detect fraud, especially latent fraud within the healthcare system
  • Patients are also abusing the healthcare system and its benefIts such as maximising number o M o days, doctor hopping and abuse of medications

How can Al detect fraud and flag out fraudulent transactions/claims?

A machine learning model (via the use of the (SWAT Iteration Framework by Keith B. Carter) was implemented into the in-house data analytics platform to detect fraud claims

 

Outcomes

  • The AI model was created with a reasonable level of accuracy and deployed to the development website for further testing by MHC. 
  • MHC was able to reduce health costs and health claims
  • New skillsets developed in AI, data engineering and business analysis – new staff were added to the MHC R&D team to work on data analytics and AI
  • MHC’s performance improved and the risk of failure was reduced
  • Increase efficient use of limited healthcare resources

PDF Document

Video link

Solution Diagram

Contact Us
The enquirer name
Company Name

Implementation Time

24 months

Use Case Brochure