Artificial Intelligence (AI) is changing the way we live, work, and receive care. But unfortunately, it’s also being used by scammers to exploit the Medicare system. Fraudsters are leveraging the trust placed in doctors, healthcare staff, and medical records—as well as the sheer complexity of healthcare data—to commit serious crimes that harm beneficiaries, waste taxpayer dollars, and undermine the integrity of Medicare.
For Hawaiʻi’s kūpuna and their families, it’s important to understand how these scams work so we can stay vigilant and protected.
AI can create realistic-looking fake medical claims, making them harder for traditional fraud detection systems to catch. These false claims may charge Medicare for services or equipment that were never provided.
Fraudsters use AI to build fake patient identities and data, then file claims under those identities. This means Medicare is billed for treatments or services that never took place.
AI-powered deepfakes—realistic but fake audio, video, or images—are particularly concerning. They can be used to:
Deepfake tools can alter medical images like X-rays or MRIs. This can create fake results, justifying fraudulent surgeries or insurance claims.
In some cases, fraudsters use AI and automation software to illegally enroll Medicare beneficiaries into Advantage plans without their knowledge or consent—putting benefits at risk.
These AI-driven schemes not only steal billions from Medicare—they also:
Agencies like the Centers for Medicare & Medicaid Services (CMS) and the Department of Justice (DOJ) are now deploying advanced tools—such as AI-powered analytics and machine learning—to detect fraud patterns more quickly. Still, awareness among beneficiaries and caregivers remains one of the strongest defenses.
➡ In our next blog, we’ll share practical steps to help protect Hawaiʻi’s kūpuna from AI scams and keep Medicare safe for future generations.
