Benefits of AI in Medicaid: How AI Reduces Costs and Medicaid Fraud
- Zack Arnold
- 3 days ago
- 3 min read
Medicaid is the source of healthcare for millions of citizens across the country, assisting families and individuals with low income, disabilities, and other challenges. As states continue to modernize their Medicaid systems, many are also looking to AI for innovative transformations that could benefit those that utilize these services.
Over 71 million people are enrolled in Medicaid and rely on its capabilities to ensure healthcare for them and their families. However, recent economic shifts have caused concern about rising Medicaid costs. In addition, states are picking up on signs of fraud and exploring ways to mitigate that risk with advanced technologies. In this article we will examine how AI can reduce costs and Medicaid fraud, helping to ensure continued care for millions.
How AI Can Reduce Medicaid Costs
As budget constraints close around Medicaid, states are looking to ways to secure the future of Medicaid and reliable healthcare for millions of Americans. It is predicted that AI could potentially save the healthcare industry up to $150 billion annually through a variety of innovative solutions. These groundbreaking technologies can reduce Medicaid costs by:
Using predictive analytics to allow healthcare providers to identify patients that are high-risk for certain conditions and diseases before they require emergency care
Pinpointing patients that are at risk of ER overuse or medication nonadherence to take steps to mitigate those costs
Predicting when disease outbreaks and demographic shifts will occur, enabling proactive allocation of valuable resources
Identifying obstructions in imaging workflows, which can lead to reduced patient wait times as well as improved scanner output and hospital revenue
Reducing prescription errors by optimizing drug regimens and flagging any medications that are not necessary, while also recognizing possibilities for new medications to have negative adverse effects, preventing complications that require a visit to the ER
How AI Can Reduce Medicaid Fraud
In the year of 2024, Medicaid reported $31.1 billion in improper payments. While some of these are due to administrative errors, others involve fraud, which can reduce money and resources available to help those on Medicaid that rely on its healthcare services. The state of Minnesota aims to utilize AI tools to combat fraud in Medicaid, as stated in a proposal by Governor Tim Walz earlier this year. With the use of AI algorithms and predictive analytics, the state can detect and flag payment anomalies for Medicaid providers.
Similarly, in Louisiana, an AI and data analysis tool is being developed by the University of Louisiana at Lafayette that the Louisiana Department of Health will use to combat fraud. National data and peer-reviewed publications that have recognized fraud are being utilized to train these AI tools so that they will be able to recognize and pinpoint similar patterns in Louisiana’s Medicaid data, enabling them to catch signs of fraud before it can occur.
Artificial intelligence has innovative potential in transforming Medicaid operations and services to improve healthcare for millions of individuals and families. With these groundbreaking tools, more funds and resources can be allocated to assisting patients and providers while improving health outcomes.
Want to learn more? Contact us at info@sednacg.com to talk to one of our AI experts or visit some of these resources:
“The great growling engine of change – technology.”
– Alvin Toffler, Writer & Futurist
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