The urgency to thwart bias through ethical AI




SAS, a vendor of analytics and artificial intelligence (AI) solutions, 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.

As an example, the South African healthcare industry has recently been wrestling with allegations of bias in the algorithms medical schemes use to detect fraud, waste, and abuse. Most recently, 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. At SAS, we are wholly commitment to ethical AI,” said Essie Mokgonyana, Country Manager and Sales Director for SAS in South Africa.

SAS is recognised for its AI and advanced analytics solutions that equip healthcare organisations with the tools to effectively manage medical costs, identify potential fraud, waste, and abuse, and make higher-value referrals 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 AI technologies are built on a foundation of strong governance and good data management practices. The use of such technologies in healthcare can provide a robust, data-driven approach to fraud detection, one that analyses all data, not just a sample, in real-time or as a batch.

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 are engineered to provide a consolidated view of fraud risk, identifying linkages among seemingly unrelated claims, allowing healthcare organisation to prevent major losses early. We believe that with transparency, constant improvement, and stringent ethics in AI, we can create an environment of trust and fairness in healthcare,” Mokgonyana added.

SAS remains committed to empowering healthcare organisations with the advanced analytics and ethical AI tools needed to secure a fair and inclusive healthcare future for all South Africans.

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