Public Health Protection Schemes are crucial in ensuring access to essential healthcare services for vulnerable sections of the population. However, fraud is a prevalent issue within these programs. From minor identity theft to more significant false claims and overbilling by healthcare providers, these attempts to defraud the system ultimately deprive those who genuinely need medical care. Furthermore, these fraudulent activities burden the already limited resources allocated for healthcare services, exacerbating the healthcare disparities prevalent in society.

Prevalent fraud in public health protection schemes erodes the citizens’ trust, deterring them from utilising the services offered. This leads to delayed medical treatment and ultimately compromises public health outcomes. Additionally, financial losses resulting from fraud reduce the availability of essential resources, including medical personnel, equipment, and medications. The resulting inequality perpetuates a cycle of ill health and poverty by depriving the most vulnerable populations of their rightful access to healthcare. Therefore, addressing and preventing fraud within public health protection schemes is imperative to ensure the equitable delivery of healthcare services to all.

The HSTP has partnered with Wadhwani AI to develop an AI-based claim fraud detection and adjudication solution for the BSKY.