One thing that strikes me from all this, the current fraud exposure along with others in MN, CA amd most other states is that the totals are approaching a significant portion of the agencies' budgets. If the budget is set to include that amount of non productive fraud, then it doesn't need to be that big! We need to begin harassing legislators to reduce appropriations appropriately, minus the fraud totals each year. That's assuming Congress can actually come up with a real budget for once...
Excellent point. If these agencies run with a fraction of the money they claim they need, then they don't really NEED it. When will the people have enough and say "No more"?
When the majority "People" become patriotic, conservative and therefore intelligent.
Ignorant leftists and the indolent who indirectly benefit from the fraud, will never say "no more" since their goal in life is more "free sh_t" from the government. Fortunately, the latter remain the minority.
Robert, This is an important effort, but it just skims the surface of the most egregious fraud and is therefore a ways away from the Philip K Dick world. The problems will accelerate as the mesh gets ever finer and decisions much closer to the line of "was that the right thing for this patient" begin to emerge.
At that point one falls into the Von Eye dilemma -- if you know everything about an individual you can confidently look at the population, but if you know everything about the population, you know NOTHING about any individual. DARPA expresses it differently...We are in WAVE 2 of Artificial intelligence as they describe (and it is well thought through by them). WAVE2 is "statistically impressive but individually unreliable". So as long as decisions are made looking at mass actions of bad actors, we are likely on better ground than any decision about a person and whether that case is fraud, waste, or abuse.
The foundational problem that you are predicting but not identifying is that there is no epistemic framework for patient health and treatment (or anything else, for that matter) in generative AI -- so it can do pattern match operations (superbly, incidentally) where the patterns are not patient specific but often fail where they are.
The solution is avoided by almost everyone -- a cognitive, deterministic, patient-centric layer needs to be added that supports patient "truth" rather than just patient patterns or the Dick scenario will almost certainly eventuate. The entire industry hopes they can avoid this by "generative AI'ing harder" just like they told us "masking harder" or "antisocial distancing harder" would solve covid. It has not and will not work, and this area should be attracting far more attention than it is. Otherwise, the slippery slope is obvious and will be followed for all the right reasons to the wrong end.
Screw CMS they are the biggest fraudsters around. Denying patient treatment because they set up a system of Medical necessity via paper reviews. Then setting up Drs who reviewed the claims which they then denied those same claims based on a whim. Having to go through the process of appeals was similar to a Kangaroo court. They robbed me of my services at the same time handing over billions of $$$$ to true fraudsters. Nice job A holes.
Agree! In another post i noted that the current system as you clearly explained is essentially what Dick was predicting, just not using AI, algorithms or psi.
Instead of devoting massive A.I. forces to rooting out billing fraud, which will then be countered by criminal deployment of massive A.I. forces to outwit the anti-fraud A.I., why not just have the patient pay the doctor, without a third party. Let the money come from a medical savings account funded by the employer, or by Medicare or Medicaid, in lieu of health insurance. This would have the side effect of making patients more active participants in their care, and incentivizing smart and informed choices about the spending of health care dollars. The insurance companies would hate it, as it will destroy their businesses and produce too much good health to feed their bottom line. It would minimize fraud, and reduce the massive expenditures of money towards the swollen health insurance bureaucracy.
"Some physician organizations and hospital groups have expressed concern that systems designed to prevent waste and abuse could eventually create barriers to legitimate patient care, particularly if algorithmic decision-making begins to replace clinical judgment." While i understand the concern, I am pretty sure we already have that situation perpretrated by those same groups with their "standard of care" requirements which are essentially algorithms themselves. And, they are already in the pre-mode per Mr. Dick when they prevent use of repurposed drugs and force "standard of care" drugs and protocols. Remdesivir, anyone??
Stealing from federal funds has been endemic for many decades. Data processing has just speed up the process with less and less oversight. President Trump is the first one not to kick the medical money fraud can down the street. Time to get the IRS involved to audit any entity that declares income from Medicare and etc. for more than $1,000,000 per year.
Easier said than done. A birth certificate is not adequate. The citizenship of the parents is a critical element often left out of discussions about citizenship.
Did you ever imagine that your genealogy had anything to do with voting?
Reminds me of an ophthalmologist in FL who billedand receivedtens of $M every year (hope it’s past tense) doing FDA approved eye procedures that have been shown to have essentially zero benefit. Factor in the inherent risks of any procedure and patients are suffering the bottom line.
Timely and excellent! To me the ramifications are extending beyond government capacities. Let me share my current experiences with the private sector. It suggests possible AI chicken and egg relationships. Ie technology applicable for both government and the private financial sectors.
Case at hand. I have 3 credit cards. Late at night, decided to make a minimal purchase of a supplement that might be useful. First try informed billing prohibited. Tried another card with same result. Credit card companies advised provider fraud. One card company cancelled and replaced my card. I will be prusuing the other. Yesterday received notice from 3rd credit card co of likely fraudulent attempt by this same provider. I had not offered existence or detail of a 3rd card to the fraudsters. This cc co refused charge, cancelled my card and is sending me a new one.
Bottom line, the private sector has made major advances in fraud prevention. This corresponds to CMS progress. Both applications are good at this point. (Noting I have personal bias here) - On the other hand, should our Nation be so foolish as to elect in another Obama/Biden style executive rulership, imo these AI capacities are ripe for "misuse"!
Thank you so much for covering these advances and concerns! Well founded and well worthy of our continued focused attentions, imo!
50% of Americans will vote for an obama biden type administration. In fact they'd vote for O and his evil dimwit B rightnow, as well as anything with a "D" after its name. Sick Society.
Great article Malones!! I would love to see a follow up to this article with pictures, names, city, and State of the perps! Let's give them the recognition that they deserve, that we can share with all of our families and friends! Let's put real pressure on!!!
I think the bureaucracy will end up using this basically against the individual claimants and taxpayers rather than the frauds. My reasoning is that I expect that much of the fraud is kicked back to the bureaucracy thru some mechanisms that I do not really understand. There is a reason that people in government jobs become wealthy while taxpayers become poor.
Yep, this is a fabulous article and a cautionary tale. Problem is we just have way too much fraud and it has to be dealt with somehow. Not sure the answer, but we can't afford the fraud if we want to retain medicare and medicaid at all. I can't even begin to imagine, though, the possible abuses of this in other areas. I'm not a big AI fan already and this is probably the first use of it all that really appeals to me. Another Frankenstein I suppose.
Quis custodiet? As the Romans asked. Anthropic's Head of Faith (of course they have one) gave a very revealing talk to the ARC Conference. She is happily preparing for the God of AI, and the Great Turning. Scared the shit out of me, this is civilization-level concern.
In terms of the perspectives of our AI leaders, was disquieted with recent Musk interview. Asked about implications of his trillionaire status, he said (to the effect) money will become irrelevant. Everyone's needs would be addressed. A new world would be coming with AI. To me, frighteningly WEFish.
I've thought for years, listening to Elon, he is using CIA type tactics to Sway Thought, Nudge us. He says ridiculous things. Truth is, no one wants AI to rule their lives, drive their cars, teach their kids, it makes zero sense.
Many like me, are trying to turn it off in our BRAVE searches now too, for example. Sorry to report that BRAVE is making it more and more difficult to do so.... from the comments I'm reading, they will soon find out, they will lose customers, unless, they allow us to EASILY block AI from our searches.
Another example, I'm right now going round and round again, in email circles, with an AI-run company. I didn't realize there was no actual people at this company! This experience has forever changed how I will shop online. Online companies trying this - will also find they will lose revenue/customers.
Lesson for all of us now - be CERTAIN there are actually People to speak to, in case you may receive a damaged product, and need a person to help you. My credit card company is ON it, thankfully, they said, don't interact with these AI emails, they have stopped payment to this AI mess.
Truth is, AI sucks. Elon is Wrong. AI can't even handle a return on an damaged item, how the heck can it replace people in Health Care situations. It's only makes a mess of things.
Coming fast. Scary? That's how they got everyone to PDQ think they needed the Real ID to fly - which you don't! FEAR. AI is going to fall on it's face, and they know it.
Not sure what you mean by falling on its face. AI is driving cars around several cities, collecting data on customers and surroundings 24/7/365. I was around computing in the early 80's when the precursors to today's Unix and Berkeley BSD were written. Over the years, the open source community examined and modified all the legacy code that runs the internet, collectively millions of man-hours in code examination and development.
Anthropic's Mythos found bugs in that code, bugs that had escaped all those hours and eyeballs. This is different.
Actually John, last night, listening to an update on world politics, I'm thinking, if China is heading toward being the new world leader, AI will have no bounds - we'll be conquered with it. We're making it easy for them. Elon disappoints me, to still be saying hyping AI, rather than using his power and money to put stops on AI. I thought he loved our country.
So will tweak my statement, and say I HOPE and PRAY AI falls on its face.
Likely similar things are going on in Social Security, on an even grander scale! That and Voter ID should change lots of things! For the definite better...
Judges (was it the useless justices, i forget) just ruled that trump's proof of citizenship is illegal. SO we are DOOMED and election fraud will continue on steroids. Just like in california and every democrat run state. Sick society. Sick corrupt govt full of corrupt politicians
Long long overdue. But an equally larger question looms - why do Democrats oppose Trump's efforts to root out fraud, waste and abuse? Maybe they really are the enemies of America and its hardworking citizens?
Have been pretty well replaced by progressives who have been implacable enemies of our Republic for over a century. The average dem appear too stupid to have noticed the takeover
One thing that strikes me from all this, the current fraud exposure along with others in MN, CA amd most other states is that the totals are approaching a significant portion of the agencies' budgets. If the budget is set to include that amount of non productive fraud, then it doesn't need to be that big! We need to begin harassing legislators to reduce appropriations appropriately, minus the fraud totals each year. That's assuming Congress can actually come up with a real budget for once...
Excellent point. If these agencies run with a fraction of the money they claim they need, then they don't really NEED it. When will the people have enough and say "No more"?
When the majority "People" become patriotic, conservative and therefore intelligent.
Ignorant leftists and the indolent who indirectly benefit from the fraud, will never say "no more" since their goal in life is more "free sh_t" from the government. Fortunately, the latter remain the minority.
Robert, This is an important effort, but it just skims the surface of the most egregious fraud and is therefore a ways away from the Philip K Dick world. The problems will accelerate as the mesh gets ever finer and decisions much closer to the line of "was that the right thing for this patient" begin to emerge.
At that point one falls into the Von Eye dilemma -- if you know everything about an individual you can confidently look at the population, but if you know everything about the population, you know NOTHING about any individual. DARPA expresses it differently...We are in WAVE 2 of Artificial intelligence as they describe (and it is well thought through by them). WAVE2 is "statistically impressive but individually unreliable". So as long as decisions are made looking at mass actions of bad actors, we are likely on better ground than any decision about a person and whether that case is fraud, waste, or abuse.
The foundational problem that you are predicting but not identifying is that there is no epistemic framework for patient health and treatment (or anything else, for that matter) in generative AI -- so it can do pattern match operations (superbly, incidentally) where the patterns are not patient specific but often fail where they are.
The solution is avoided by almost everyone -- a cognitive, deterministic, patient-centric layer needs to be added that supports patient "truth" rather than just patient patterns or the Dick scenario will almost certainly eventuate. The entire industry hopes they can avoid this by "generative AI'ing harder" just like they told us "masking harder" or "antisocial distancing harder" would solve covid. It has not and will not work, and this area should be attracting far more attention than it is. Otherwise, the slippery slope is obvious and will be followed for all the right reasons to the wrong end.
Screw CMS they are the biggest fraudsters around. Denying patient treatment because they set up a system of Medical necessity via paper reviews. Then setting up Drs who reviewed the claims which they then denied those same claims based on a whim. Having to go through the process of appeals was similar to a Kangaroo court. They robbed me of my services at the same time handing over billions of $$$$ to true fraudsters. Nice job A holes.
Agree! In another post i noted that the current system as you clearly explained is essentially what Dick was predicting, just not using AI, algorithms or psi.
Instead of devoting massive A.I. forces to rooting out billing fraud, which will then be countered by criminal deployment of massive A.I. forces to outwit the anti-fraud A.I., why not just have the patient pay the doctor, without a third party. Let the money come from a medical savings account funded by the employer, or by Medicare or Medicaid, in lieu of health insurance. This would have the side effect of making patients more active participants in their care, and incentivizing smart and informed choices about the spending of health care dollars. The insurance companies would hate it, as it will destroy their businesses and produce too much good health to feed their bottom line. It would minimize fraud, and reduce the massive expenditures of money towards the swollen health insurance bureaucracy.
"Some physician organizations and hospital groups have expressed concern that systems designed to prevent waste and abuse could eventually create barriers to legitimate patient care, particularly if algorithmic decision-making begins to replace clinical judgment." While i understand the concern, I am pretty sure we already have that situation perpretrated by those same groups with their "standard of care" requirements which are essentially algorithms themselves. And, they are already in the pre-mode per Mr. Dick when they prevent use of repurposed drugs and force "standard of care" drugs and protocols. Remdesivir, anyone??
Bingo!!!
Stealing from federal funds has been endemic for many decades. Data processing has just speed up the process with less and less oversight. President Trump is the first one not to kick the medical money fraud can down the street. Time to get the IRS involved to audit any entity that declares income from Medicare and etc. for more than $1,000,000 per year.
Let's also check citizenship status.
A given! Unfortunately we have brain dead adminstrors!
Easier said than done. A birth certificate is not adequate. The citizenship of the parents is a critical element often left out of discussions about citizenship.
Did you ever imagine that your genealogy had anything to do with voting?
Probably, I was lucky. No silver spoon, but two loving parents that never made it beyond 8th grade.
We are all lucky, or blessed. My grandfather quit high school to support his widowed step mom. Life has never been easy.
Reminds me of an ophthalmologist in FL who billedand receivedtens of $M every year (hope it’s past tense) doing FDA approved eye procedures that have been shown to have essentially zero benefit. Factor in the inherent risks of any procedure and patients are suffering the bottom line.
Timely and excellent! To me the ramifications are extending beyond government capacities. Let me share my current experiences with the private sector. It suggests possible AI chicken and egg relationships. Ie technology applicable for both government and the private financial sectors.
Case at hand. I have 3 credit cards. Late at night, decided to make a minimal purchase of a supplement that might be useful. First try informed billing prohibited. Tried another card with same result. Credit card companies advised provider fraud. One card company cancelled and replaced my card. I will be prusuing the other. Yesterday received notice from 3rd credit card co of likely fraudulent attempt by this same provider. I had not offered existence or detail of a 3rd card to the fraudsters. This cc co refused charge, cancelled my card and is sending me a new one.
Bottom line, the private sector has made major advances in fraud prevention. This corresponds to CMS progress. Both applications are good at this point. (Noting I have personal bias here) - On the other hand, should our Nation be so foolish as to elect in another Obama/Biden style executive rulership, imo these AI capacities are ripe for "misuse"!
Thank you so much for covering these advances and concerns! Well founded and well worthy of our continued focused attentions, imo!
50% of Americans will vote for an obama biden type administration. In fact they'd vote for O and his evil dimwit B rightnow, as well as anything with a "D" after its name. Sick Society.
Great article Malones!! I would love to see a follow up to this article with pictures, names, city, and State of the perps! Let's give them the recognition that they deserve, that we can share with all of our families and friends! Let's put real pressure on!!!
I think the bureaucracy will end up using this basically against the individual claimants and taxpayers rather than the frauds. My reasoning is that I expect that much of the fraud is kicked back to the bureaucracy thru some mechanisms that I do not really understand. There is a reason that people in government jobs become wealthy while taxpayers become poor.
If this fraud would have been stopped on day one Medicare S.S.
would not be running out of funds. So, who really gets stuck with Gooberment,
failures, the USA Citizen who pays taxes! and paid into these funds all there life,
Medicare and S. S. - and will be stuck yet again for POOR GOOBERMENT !
Yep, this is a fabulous article and a cautionary tale. Problem is we just have way too much fraud and it has to be dealt with somehow. Not sure the answer, but we can't afford the fraud if we want to retain medicare and medicaid at all. I can't even begin to imagine, though, the possible abuses of this in other areas. I'm not a big AI fan already and this is probably the first use of it all that really appeals to me. Another Frankenstein I suppose.
Punishment commiserate with the crime would be a good start but would require extensive clearing benches of progressive judges
Absolutely, clearing the corrupt judges out is what is needed!
commensurate
Thanks
Frustrating that the caring and kindness behind these funds is violated by parasitic thieves.
Quis custodiet? As the Romans asked. Anthropic's Head of Faith (of course they have one) gave a very revealing talk to the ARC Conference. She is happily preparing for the God of AI, and the Great Turning. Scared the shit out of me, this is civilization-level concern.
In terms of the perspectives of our AI leaders, was disquieted with recent Musk interview. Asked about implications of his trillionaire status, he said (to the effect) money will become irrelevant. Everyone's needs would be addressed. A new world would be coming with AI. To me, frighteningly WEFish.
I've thought for years, listening to Elon, he is using CIA type tactics to Sway Thought, Nudge us. He says ridiculous things. Truth is, no one wants AI to rule their lives, drive their cars, teach their kids, it makes zero sense.
Many like me, are trying to turn it off in our BRAVE searches now too, for example. Sorry to report that BRAVE is making it more and more difficult to do so.... from the comments I'm reading, they will soon find out, they will lose customers, unless, they allow us to EASILY block AI from our searches.
Another example, I'm right now going round and round again, in email circles, with an AI-run company. I didn't realize there was no actual people at this company! This experience has forever changed how I will shop online. Online companies trying this - will also find they will lose revenue/customers.
Lesson for all of us now - be CERTAIN there are actually People to speak to, in case you may receive a damaged product, and need a person to help you. My credit card company is ON it, thankfully, they said, don't interact with these AI emails, they have stopped payment to this AI mess.
Truth is, AI sucks. Elon is Wrong. AI can't even handle a return on an damaged item, how the heck can it replace people in Health Care situations. It's only makes a mess of things.
Watch the speech by Chloe Lubinski at ARC on YouTube, and read about the Great Turning. Chilling stuff and it's coming fast.
Coming fast. Scary? That's how they got everyone to PDQ think they needed the Real ID to fly - which you don't! FEAR. AI is going to fall on it's face, and they know it.
Not sure what you mean by falling on its face. AI is driving cars around several cities, collecting data on customers and surroundings 24/7/365. I was around computing in the early 80's when the precursors to today's Unix and Berkeley BSD were written. Over the years, the open source community examined and modified all the legacy code that runs the internet, collectively millions of man-hours in code examination and development.
Anthropic's Mythos found bugs in that code, bugs that had escaped all those hours and eyeballs. This is different.
Actually John, last night, listening to an update on world politics, I'm thinking, if China is heading toward being the new world leader, AI will have no bounds - we'll be conquered with it. We're making it easy for them. Elon disappoints me, to still be saying hyping AI, rather than using his power and money to put stops on AI. I thought he loved our country.
So will tweak my statement, and say I HOPE and PRAY AI falls on its face.
China is going to try to prove that AI will be the technology behind the perfect surveillance state.
The best we can hope for here is an imperfect surveillance state.
Likely similar things are going on in Social Security, on an even grander scale! That and Voter ID should change lots of things! For the definite better...
Judges (was it the useless justices, i forget) just ruled that trump's proof of citizenship is illegal. SO we are DOOMED and election fraud will continue on steroids. Just like in california and every democrat run state. Sick society. Sick corrupt govt full of corrupt politicians
Long long overdue. But an equally larger question looms - why do Democrats oppose Trump's efforts to root out fraud, waste and abuse? Maybe they really are the enemies of America and its hardworking citizens?
Have been pretty well replaced by progressives who have been implacable enemies of our Republic for over a century. The average dem appear too stupid to have noticed the takeover
You two are heroes!
Thank you!