The Centers for Medicare and Medicaid Services (CMS) provides health coverage to more than 160 million people across the country. GDIT has supported CMS for over 40 years to provide access to high quality health care. CMS seeks to improve the health of our citizens with Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace.
Fraud in Health is Challenging to Identify
Fraud is a critical issue in U.S. healthcare with estimates showing the problem could represent as much as 10% of a $4 trillion market. With a massive 4.5 million claims processed each day, and the ever evolving sophistication of fraud schemes, it is challenging to identify fraud in Medicare.
GDIT Deploys AI to Identify Fraud at Speed
GDIT continuously develops solutions to systematically detect and prevent inappropriate payments by combining advanced analytics with subject matter expertise in healthcare data and payment policies. The company developed the first AI and machine learning model in production for the CMS, identifying fraud schemes with more complex patterns than humans could previously detect. In two years, the AI model outperformed manual methods.
With greater than 90% accuracy in detection and by cutting the time to develop fraud models from months down to minutes, GDIT's AI identifies more than $1 billion worth of suspect claims each year.