Leveraging AI to Improve Eligibility Verification and Fraud Detection in Health and Human Services Agencies (Public Sector)

Abstract: Artificial Intelligence (AI) is revolutionizing eligibility verification processes in Health and Human Services (HHS) agencies, offering significant improvements in efficiency and accuracy. This study examines the role of AI in streamlining operations, enhancing fraud detection, and optimizing resource allocation within HHS eligibility verification systems. By leveraging machine learning algorithms, AI can rapidly analyze vast datasets, cross-reference information with existing databases, and identify patterns that may indicate eligibility or potential fraud. The implementation of AI not only accelerates the decision-making process but also reduces human error, particularly in complex cases. Moreover, AI's ability to flag discrepancies for human review allows agencies to focus their resources on high-risk cases, potentially preventing fraudulent claims and ensuring that services reach those truly in need. This research highlights the transformative potential of AI in HHS eligibility verification and its natural progression towards more sophisticated fraud detection mechanisms, ultimately improving the integrity and effectiveness of social service programs.Keywords: Artificial Intelligence (AI), Government Public Sector, Health and Human Services (HHS), Salesforce, Apex, AWS, Fraud Detection.