Robert, This is an important effort, but it just skims the surface of the most egregious fraud and is therefore a ways way 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.
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...
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.
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!
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.
"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??
Suggestion for Trumpie to leverage return of US assetss due to foreign involvement in Medicare fraud:
Let's say Estonian criminals bilked the US of 3 billion $.
-- The perps get tried & sentenced in US but put in jail in Estonia with yearly confirmation to US penal institutions for whatever the US judgement says. The USA does not pay for their upkeep. -- Estonia loses 10 years of any money the US gov has been giving them or 10 times the amount of money bilked-- whichever is More.
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?
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.
Medical Care is not Health Care...I have no desire to go to doctors who dispense toxic drugs and poisonous vaccines. The whole premise of modern medicine is health destroying. The DRUGS, VACCINES and TREATMENTS promote disease. There are NO CURES! MEDICARE is a financial drain on Americans, which would be totally unnecessary, if our government promoted real health. Everything the government does has contributed to the lowering of American's health, because it has focused on MONEY FIRST promoting many industries which have contributed to the lowering of the health of every American. Good health is a DIY thing...it can't be bought. Hippocrates, the Father of medicine 2400 years ago PRODUCED CURES for his patients. He prescribed natural foods, exercise, sunshine, fresh air, a healthy lifestyle with the avoidance of toxins...Hippocrates would never have prescribed toxic drugs, which poison the internal organs. The bloodstream's function is to carry nutrients from food to NOURISH every organ and gland in the body. Why isn't Hippocrates information taught in med school to future doctors? It appears that the medical Industry is not interested in CURES!
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.
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.
"We need effective legislation put in place now" like last year! When the media isn't covering this huge scandal more closely indicates that the majority will be left in the dark.
Robert, This is an important effort, but it just skims the surface of the most egregious fraud and is therefore a ways way 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.
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...
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.
Watch the speech by Chloe Lubinski at ARC on YouTube, and read about the Great Turning. Chilling stuff and it's coming fast.
You two are heroes!
Thank you!
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!
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.
"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??
Suggestion for Trumpie to leverage return of US assetss due to foreign involvement in Medicare fraud:
Let's say Estonian criminals bilked the US of 3 billion $.
-- The perps get tried & sentenced in US but put in jail in Estonia with yearly confirmation to US penal institutions for whatever the US judgement says. The USA does not pay for their upkeep. -- Estonia loses 10 years of any money the US gov has been giving them or 10 times the amount of money bilked-- whichever is More.
-- Estonia tariffs doubled for 5 years
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?
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.
Medical Care is not Health Care...I have no desire to go to doctors who dispense toxic drugs and poisonous vaccines. The whole premise of modern medicine is health destroying. The DRUGS, VACCINES and TREATMENTS promote disease. There are NO CURES! MEDICARE is a financial drain on Americans, which would be totally unnecessary, if our government promoted real health. Everything the government does has contributed to the lowering of American's health, because it has focused on MONEY FIRST promoting many industries which have contributed to the lowering of the health of every American. Good health is a DIY thing...it can't be bought. Hippocrates, the Father of medicine 2400 years ago PRODUCED CURES for his patients. He prescribed natural foods, exercise, sunshine, fresh air, a healthy lifestyle with the avoidance of toxins...Hippocrates would never have prescribed toxic drugs, which poison the internal organs. The bloodstream's function is to carry nutrients from food to NOURISH every organ and gland in the body. Why isn't Hippocrates information taught in med school to future doctors? It appears that the medical Industry is not interested in CURES!
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.
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.
Will any of the fraudsters be sentenced to hard labor to recoup what they have stolen? Let's bring back some real punishments.
"We need effective legislation put in place now" like last year! When the media isn't covering this huge scandal more closely indicates that the majority will be left in the dark.
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 !