AI System Set to Detect Healthcare Fraud in Cyprus GHS
The Health Insurance Organisation launched a €600,000 AI project to detect fraud and abuse in the General Healthcare System. The system will analyze provider data and claims independently to improve healthcare integrity.
GHS Implements AI to Detect Healthcare Fraud
The Health Insurance Organisation (HIO) has launched a €600,000 project to develop an artificial intelligence system aimed at identifying fraud, abuse, and poor practices within the General Healthcare System (GHS). This new system will analyse millions of data entries independently from the current GHS software.
HIO Director Constantinos Panagides described the initiative as "massive and ambitious," involving collaboration between the contractor, subcontractors, and two key HIO departments: IT and Claims.
How the AI System Will Work
The AI will scrutinize healthcare provider data to detect patterns indicative of fraud or abuse. It will also review reimbursement claims for potential errors or intentional misrepresentations. Additionally, the system will monitor services provided to specific patient groups to ensure appropriate care.
For example, in the case of diabetic patients, the AI will assess physician practices by examining referrals for tests, test frequency, and pharmaceutical treatments. This helps flag instances where patients may be receiving either excessive or insufficient services.
Once suspicious patterns are identified, the HIO can investigate further, impose penalties, or introduce measures to prevent abuse.
Organizational Collaboration and Future Steps
The HIO has set up working groups across all departments to define monitoring requirements for various service categories such as radiology, pharmaceuticals, and hospital care. While the project is complex and will take approximately 30 months to complete, the goal is to deliver results as quickly as possible.
Following the system’s completion, HIO staff will receive training to operate it effectively. Over time, the organisation plans to expand the system’s capabilities, complementing the existing GHS software which has already streamlined many healthcare procedures.
Project Launch and Next Phases
The official launch phase began with a presentation of objectives and requirements to the contractor and partners. This marks the start of 30 months of development, after which the AI system will play a critical role in safeguarding the integrity of healthcare services under the GHS.
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