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12 cases found

Chile Design & Development Phase

SUSESO ML-Based Medical Insurance Claims Processing

Classification Operational and process automation

Chile's Superintendencia de Seguridad Social (SUSESO), the social security and medical insurance...

Confirmed Classical ML
France Full Production Deployment

CNAM AI Healthcare Fraud Detection

Anomaly and change detection Compliance and integrity

The Caisse nationale de l'assurance maladie (CNAM), France's national health insurance fund, has...

Confirmed Classical ML 2020
Colombia Scaled & Institutionalised

SISBEN IV -- AI-Enhanced Data Analytics and Fraud Detection Layer for Social Programme Targeting

Classification Decision support for eligibility and benefits

Colombia's Sistema de Identificacion de Potenciales Beneficiarios de Programas Sociales (SISBEN),...

Confirmed Classical ML 1994
Togo Pilot / Controlled Trial Phase

Novissi -- Machine Learning Model Performance Monitoring and Bias Detection

Classification Policy analysis, learning and M&E

The Government of Togo, in collaboration with academic research partners from the University of...

Confirmed Classical ML 2020
Korea, Rep. Full Production Deployment

National Health Insurance Service (NHIS) – Machine Learning-Based Fraud Detection and Prediction System

Anomaly and change detection Compliance and integrity

The National Health Insurance Service (NHIS) of the Republic of Korea operates a machine...

Confirmed Classical ML 2020
India Full Production Deployment

AI-Enabled Fraud Detection and Analytics for India's National Health Insurance Scheme (AB PM-JAY)

Anomaly and change detection Compliance and integrity

The Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) fraud detection system is an...

Confirmed Hybrid 2020
Indonesia Scaled & Institutionalised

BPJS Kesehatan DEFRADA ML Fraud Detection in Healthcare Claims (Indonesia)

Anomaly and change detection Compliance and integrity

BPJS Kesehatan (Badan Penyelenggara Jaminan Sosial Kesehatan), Indonesia's national health...

Confirmed Classical ML 2017
Ghana Operational Deployment (Limited Rollout)

NHIA AI-Enabled Claims Fraud Detection and Audit Analytics (Ghana)

Anomaly and change detection Compliance and integrity

The National Health Insurance Authority (NHIA) of Ghana operates an AI-enabled claims integrity...

Likely Classical ML 2023
France Full Production Deployment

CNAF Algorithmic Risk Scoring for Family Benefits Fraud Detection

Classification Compliance and integrity

The Caisse Nationale des Allocations Familiales (CNAF), the national family allowance fund within...

Confirmed Classical ML 2010
Germany Pilot / Controlled Trial Phase

KIRA (AI for Risk-Based Employer Audits)

Anomaly and change detection Compliance and integrity

KIRA — Künstliche Intelligenz für risikoorientierte Arbeitgeberprüfungen (Artificial Intelligence...

Confirmed Classical ML 2025
Chile Operational Deployment (Limited Rollout)

ISL/ACHS eTóraxLaboral AI Pneumoconiosis Detection System (Deep Learning Chest X-ray Analysis)

Perception and extraction from unstructured inputs Decision support for eligibility and benefits

Chile's Instituto de Seguridad Laboral (ISL) and the Asociación Chilena de Seguridad (ACHS), in...

Confirmed Deep learning 2024
Austria Full Production Deployment

KAI System – AI-based Semi-Automatic Reimbursement of Medical Services Fees

Perception and extraction from unstructured inputs Operational and process automation

The KAI system (Künstliche Intelligenz in der Kostenerstattung) is an artificial intelligence...

Confirmed Classical ML 2019