Blue Cross Blue Shield of Massachusetts uses an AI algorithm that scans claims data and flags suspicious billing activity before a claim is paid, enabling the company's fraud investigation team to review potential cases proactively. This system replaced a prior process that only recovered money after fraudulent claims were already paid.

The algorithm combs through large volumes of claims data — including known fraud schemes and other public data sources — and flags suspicious billing practices for human review before payment is issued. Flagged claims are frozen and uploaded to a dashboard for the fraud investigation team to review; if confirmed fraudulent, claims are denied and may be reported to law enforcement. The company reported that 65–70% of the algorithm's leads turned out to be confirmed cases of potential fraud.