CMS seeks feedback on how AI could improve Medicare

CMS has announced a new plan to “modernize” Medicare and find new ways to “protect taxpayers from fraud, waste and abuse.” Could AI technologies play key role in the agency’s strategy?

CMS Administrator Seema Verma made the announcement on Oct. 21, sharing a detailed blog post on the CMS website. The executive order signed by President Donald Trump on Oct. 3 called for new ways to fight waste, fraud and abuse, Verma explained, and that’s what CMS aims to do with this new plan.

“Program integrity must focus on paying the right amount, to legitimate providers, for covered, reasonable and necessary services provided to eligible beneficiaries while taking aggressive actions to eliminate fraud, waste and abuse,” Verma wrote. “Our healthcare programs are quickly evolving; therefore our program integrity strategy must keep pace to address emerging challenges.”

In her blog post, Verma wrote that CMS is working to take advantage of advanced technologies in the near future to help the agency reach its goals.

“Looking forward, CMS is seeking new, innovative strategies and technologies, perhaps involving artificial intelligence and/or machine learning, which are more cost effective and less burdensome to both providers, suppliers and the Medicare program,” she wrote. “This new technology could allow the Medicare program to review compliance on more claims with less burden on providers and less cost to taxpayers.”

Verma added that AI could potentially lead to “more expeditious, seamless and accurate medical review, and ultimately, improved payment accuracy.” She also requested input on “new techniques and approaches” that use advanced data analytics and AI, noting a series of meetings designed to discuss such ideas will be held throughout the United States.

“Simply stated, CMS must elevate program integrity, unleash the power of modern private sector innovation, prevent rather than chase fraud waste and abuse through smart, proactive measures, and unburden our provider partners so they can do what they do best—put patients first,” Verma concluded.

More information about this Request for Information from CMS is available here.