HHS Launches AI Screening to Prevent Fraud Before Health Payments

The U.S. Department of Health and Human Services has launched a new initiative using artificial intelligence to screen for fraud and improper payments before funds are disbursed across major federal health programs. The effort, which began operational steps in May, marks a significant shift from the government's long-standing "pay and chase" model of recovering money after it is spent.

The initiative applies to Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace. Officials said the AI tools are designed to flag suspicious claims and audit patterns in real time, prior to payment. In a February announcement, HHS Secretary Robert F. Kennedy Jr., Centers for Medicare & Medicaid Services Administrator Mehmet Oz, and Vice President JD Vance framed the change as a move toward a "detect and deploy" strategy to safeguard taxpayer funds.

The push comes amid substantial estimates of improper payments. According to agency data, Medicare's fee-for-service program alone accounted for an estimated $28.83 billion in improper payments in the last fiscal year, with Medicare Part C adding another $23.67 billion. A separate government report placed...