SAS, a leader in analytics and artificial intelligence [AI], underscores the urgency of eliminating bias through the use of ethical AI in response to the growing concerns around automated claim processing in the health care sector.
Recently, the South African healthcare industry faced bias allegations in the algorithms used by medical schemes to detect fraud. An interim report by an independent panel raised concerns about racial discrimination against black medical service providers.
“We view such allegations seriously and understand the concerns about algorithmic bias. “We are fully committed to ethical AI,” stated Essie Mokgonyana, SAS Country Manager and Sales Director in South Africa.
SAS earns recognition for its AI and advanced analytics solutions, empowering healthcare organizations with the tools to effectively manage medical costs, identify potential fraud, waste, and abuse, and refer higher-value cases to regulators and law enforcement.
Today, these capabilities have never been more crucial. As AI continues to transform how medical schemes process vast volumes of claims, the necessity to ensure transparency, fairness, and impartiality in AI systems is paramount.
“SAS develops AI technologies with a focus on transparency and interpretability. This means we can explore what goes into our models, understand why they make certain decisions, and critically, ensure they are free of bias. Our goal is to enhance the health care industry with AI that is responsible, reliable, and ethical,” Mokgonyana emphasised.
SAS bases its AI technologies on strong governance and data management practices, offering a robust, data-driven approach to fraud detection in healthcare.
However, Mokgonyana notes that AI, while powerful, is only as good as the data it learns from. Ensuring the quality of data is a responsibility shared by all stakeholders. SAS encourages a more collaborative effort from industry players in developing and refining these technologies, ensuring that AI can truly serve its purpose of advancing patient care and protecting resources for the greater good.
In the wake of recent developments, SAS is dedicated to helping the local industry navigate these challenging issues. To this end, the company offers SAS Payment Integrity for Health Care, which uses advanced analytics combined with embedded AI and machine learning algorithms to detect fraud and reduce false positives, all while optimising payment integrity.
SAS solutions provide a consolidated view of fraud risk, allowing healthcare organizations to detect linkages among claims and prevent losses. Mokgonyana emphasized transparency, continuous improvement, and ethical AI for building trust and fairness in healthcare.