The Department of Health and Human Services is moving from “pay and chase” to real-time AI screening across Medicare, Medicaid, CHIP and the Marketplace.
The US Department of Health and Human Services has launched an artificial intelligence initiative aimed at detecting fraud and waste across federal health programmes, building on a strategy first outlined in February that promises to replace the federal “pay and chase” model with real-time screening of claims before they are paid. Reuters reported the development on Wednesday.
The programme covers Medicare, Medicaid, the Children’s Health Insurance Programme and the Health Insurance Marketplace, according to the joint HHS announcement from earlier this year.
In that February rollout, HHS Secretary Robert F. Kennedy Jr, Vice President JD Vance and CMS Administrator Mehmet Oz framed the shift as moving from a decades-old approach of paying claims first and investigating later to what the agency calls a “detect and deploy” model, using AI tools to flag suspicious claims at the point of adjudication.
The numbers behind the push are large enough to explain the urgency. Medicare’s fee-for-service programme alone made an estimated $28.83bn in improper payments in fiscal 2025, according to a CMS fact sheet; Medicare Part C added another $23.67bn.
