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