Groundbreaking AI solution recognized as best-in-class for combating Medicare fraud
Milliman, Inc. is proud to announce that it has been selected as the winner of the Centers for Medicare & Medicaid Services (CMS) “Crushing Fraud Chili Cook-Off” Competition. This recognition highlights Milliman’s pioneering work in applying explainable artificial intelligence (AI) to strengthen public sector program integrity through advanced fraud, waste, and abuse (FWA) analytics.
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Milliman’s winning solution stood out for its ability to deliver actionable intelligence with clarity and accountability. By combining actuarial principles with advanced anomaly detection, Milliman’s tool empowers investigators to identify fraud, waste, and abuse with unprecedented clarity and transparency. Using a glass box approach that allows users to understand how decisions are made (in contrast to opaque black-box solutions), the system surfaces potential fraud cases and provides actionable, auditable evidence. By producing a composite risk score for every provider in the limited data set provided to Cook-Off finalists, Milliman’s tool enables program integrity teams to quickly prioritize investigations and uncover coordinated fraud networks.
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“This award by CMS is a testament to the power of pairing actuarial rigor with modern AI,” said Paul Houchens, Milliman Principal & Consulting Actuary. “CMS challenged the industry to bring forward solutions that could move fraud prevention from reactive to proactive. We wish to express our gratitude to CMS Administrator Oz and CMS for arranging this contest. We are honored that Milliman’s approach has been recognized as the most effective and scalable.”
Milliman was selected as one of ten finalists based on its research proposal to CMS. Finalists received access to Medicare fee-for-service claims data from CMS, to which they could apply their AI techniques. Following presentation of the analysis results as well as scalability and policy solutions, Milliman was selected as the winner of the competition.
“Winning this competition affirms our commitment to transparency and accountability in healthcare analytics,” said Prasenjit Singh, Milliman Senior Data Engineer and Architect. “We look forward to collaborating with CMS to deploy this solution more broadly, safeguarding Medicare’s future and strengthening trust in publicly funded health programs.”
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Source- businesswire
