Agency leader says AI is helping resource-strained workforce identify more fraud

An anti-fraud official from the Centers for Medicare and Medicaid Services said that artificial intelligence is enhancing her workforce’s capability to spot scams. 

“There's a lot of fraud in the healthcare sector. The estimates on the conservative side are about $100 billion and, depending on who else you talk to, you can easily double or triple that with different calculations,” said Jeneen Iwugo — the acting director for the CMS Center for Program Integrity — at the UiPath Public Sector Summit on Tuesday. “I have a modest budget of $1 billion, so the size of the problem is much bigger than the budget I'm given to find it.”

Specifically, Iwugo explained that AI tools are helping CPI’s roughly 500 employees better identify fraud across the four to five million claims they review every day. 

“My team uses AI to comb through those claims and that data and figure out where the risk is the greatest,” she said. “I cannot investigate everything that looks weird, so I have to restratify my work to make sure that I am auditing and reviewing those instances where we have the biggest risk for something fraudulent happening.” 

Iwugo emphasized that the Trump administration’s prioritization of combating fraud has given her office more flexibility. 

“The longer leash I get, the more I'm able to push the needle with using AI, getting into the agentic AI space, the more of that $100 billion I'll be able to recapture,” she said. 

Going forward, Iwugo stated that CMS is piloting programs in which AI doesn’t just review potentially fraudulent claims but also recommends to employees what the possible penalties could be. 

“Once I get there, I will be able to take off and capture a lot more of the fraud that I know exists, that I'm able to detect, but that I'm just watching because I can't move fast enough,” she said. 

Iwugo also touted that CPI in fiscal 2024 saved Medicare an estimated $26.3 billion, which is a return on investment of $14.6 for every $1 invested and an improvement from fiscal 2023 when the agency projected that it recovered $14.9 billion.  

Agencies reported there were 3,611 individual AI use cases in 2025, which is more than double from 2024. The Veterans Affairs Department, as one example, is using the technology to speed up processing of veterans’ benefits claims, but congressional Democrats argued that it is worsening error rates.