Groundbreaking AI solution recognized as best-in-class for combating Medicare fraud
SEATTLE--(BUSINESS WIRE)--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.
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.
“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.”
To learn more about Milliman’s winning solution, organizations should contact their Milliman consultant or more.info@milliman.com.
About Milliman
Milliman leverages deep expertise, actuarial rigor, and advanced technology to develop solutions for a world at risk. We help clients in the public and private sectors navigate urgent, complex challenges—from extreme weather and market volatility to financial insecurity and rising health costs—so they can meet their business, financial, and social objectives. Our solutions encompass insurance, financial services, healthcare, life sciences, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe. Visit us at milliman.com.
Contacts
Jeremy Engdahl-Johnson
Milliman, Inc.
Tel: +1 646.473.3021
Jeremy.engdahl-johnson@milliman.com
