Anomaly CEO Mike Desjadon recently joined CNBC’s The Exchange to discuss the financial impact of federal healthcare policies on Medicare and Medicaid. In conversation with host Kelly Evans, Desjadon highlighted the role of AI and technology in finding and reducing fraud, waste, and abuse within government healthcare payment systems.
Recent administrative changes have resulted in thousands of job cuts across the Department of Health and Human Services (HHS), including key agencies such as the CDC and FDA. While these reductions may generate headlines, Desjadon pointed out that the real cost-saving opportunities lie within Medicare and Medicaid payments, which amount to nearly $2 trillion annually.
“The bulk of what you can do is really look at where the money is going,” Desjadon explained. “It’s less about personnel cuts and more about ensuring funds are being allocated correctly.”
According to a 2023 Government Accountability Office report, improper payments within Medicare and Medicaid totaled approximately $100 billion. However, Desjadon believes this is just the tip of the iceberg. Due to the complexity of the billing system, the full extent of financial mismanagement remains unknown.
“There’s a significant chunk of payments that represent fraud, waste, and abuse—technology can absolutely help address that,” Desjadon emphasized. “The real challenge is that we don’t even know how big the problem is.”
Medicare Advantage, initially designed to lower costs through value-based incentives, has expanded significantly, now covering over 52% of seniors. However, Desjadon noted that instead of reducing costs, the program has led to increased government spending without clear oversight of how the funds are being utilized.
“We need better ways to track where the money is actually going,” he said. “Is it being spent on patient care, or is it being denied? That’s a problem technology can help solve.”
When asked what actions should be taken to improve healthcare payments, Desjadon outlined two key solutions:
“Just like any private sector company, the government should be asking: ‘Should I have paid this or not?’” Desjadon concluded. “AI and automation can provide that oversight.”
As healthcare costs continue to rise, leveraging technology to improve payment integrity will be essential. Companies like Anomaly are at the forefront of driving efficiency in healthcare payments, ensuring that funds are spent effectively and transparently.
