Source: in-cyprus.philenews.com
The Health Insurance Organisation (HIO) has begun developing an artificial intelligence system to analyse millions of entries in the General Healthcare System (GHS) database and identify potential fraud, abuse and poor practices.
The €600,000 project, awarded through a completed tender process, will take 30 months to complete and operate independently of the existing GHS software while analysing its data entries.
“This is a massive and ambitious project,” HIO Director Constantinos Panagides told Phileleftheros, adding that teams from the contractor, subcontractors and two HIO departments – IT and Claims – would collaborate on the development.
The system will analyse data from healthcare provider entries to detect fraud or abuse patterns, examine reimbursement claims for errors or intentional misrepresentations, and monitor services provided to specific patient groups.
For diabetic patients, the system will analyse physician practices including examination referrals, frequency of tests and pharmaceutical treatments to identify cases where patients receive excessive or insufficient services.
“When we have these indicators, we can proceed either with investigating a case and imposing penalties if necessary, or implementing measures or restrictions to prevent abuse,” Panagides said.
The HIO has established working groups involving all organisational departments to define requirements for monitoring different service categories, including radiological services, pharmaceuticals and hospital care.
“We have a long road and much work ahead. We’re starting now but our goal is to complete this as quickly as possible, keeping in mind that the project is both difficult and complex,” Panagides said.
HIO staff will receive training to operate the system once completed. The organisation expects to enhance the system’s capabilities over time.
The GHS software currently provides numerous capabilities and has eliminated many procedures that other global healthcare systems still maintain, according to Panagides. The new AI system will complement these existing functions.
The first presentation of objectives and requirements to the contractor and partners took place yesterday, marking the project’s official launch phase.
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