How AI is being used to stop dental insurance fraud

West Hollywood, Calif.-based startup Pearl has developed artificial intelligence to help combat dental insurance fraud, according to The Wall Street Journal.

The software is based on a dataset of tens of millions of dental images, such as X-rays, three-dimensional images and intraoral photography. When insurance providers receive claims, Pearl's machine learning tool compares images to detect duplicates and near duplicates. Then AI technology is used to determine if the image matches the procedure described in the claim.

Pearl claims that its AI solution has identified thousands of cases in which dentists are using repeat X-rays or other medical images to bill insurers. Liberty Dental Plan Corp. is one of the insurers that has teamed up with Pearl. The insurer says that annually between 17 percent and 20 percent of their claims are fraudulent.

"Our primary goal is to shed light and to provide analysis and real-time information so that the appropriate action can be taken," said Ophir Tanz, CEO and founder of Pearl, to WSJ.

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