A new artificial intelligence (AI) tool is being developed to monitor the vast amount of data recorded in Cyprus’ national health scheme (Gesy), aiming to expose potential fraud, misuse, or poor medical practices.

The move is seen as a bold step by the health insurance organisation (HIO), which oversees Gesy, to enhance the quality of care and protect public funds.

The system will analyse millions of healthcare entries, offering insights that could help identify irregularities such as unnecessary treatments, suspicious claims, or substandard care. Its development is already underway, following the conclusion of a competitive tender awarded to a specialised technology firm.

HIO director Konstantinos Panayides described the project as “ambitious and complex”, involving a large team of IT experts and analysts. Work has now begun, with two HIO departments, information technology and claims, working alongside the private contractor and subcontractors.

Panayides explained that once complete, the AI platform will sift through provider-submitted data, spotting trends or patterns that point to fraud or overuse. 

“When we have these indicators,” he said, “we’ll be in a position to investigate further and, if needed, impose penalties or introduce restrictions to prevent future misuse.”

The system will also examine reimbursement claims filed by healthcare providers. It will flag potential errors, whether accidental or intentional, helping to reduce false payments and reinforce accountability.

But the tool is not just about catching wrongdoing. It will also assess the quality and suitability of medical services by a specific patient group. Panayides gave the example of diabetes care, where the system will track how consistently patients are treated, including which tests are ordered and how often, as well as what medication is prescribed.

“This will help us spot cases where a diabetic patient might be receiving too many or too few services,” Panayides said. 

“From there, we can act in the patient’s best interest, either preventing abuse or ensuring proper care is being provided.”

The AI system is expected to operate independently of Gesy’s main software. It will not alter existing records but instead analyse them in the background. This means it can be integrated without disrupting current medical or administrative workflows.

With a price tag of over €600,000, the system is scheduled to be completed within 30 months. Staff within the HIO will be trained to manage and operate the tool once it’s up and running.

Panayides confirmed that the agency has spent considerable time preparing for this project. 

“We’ve already outlined our expectations and presented the structure of Gesy to the contractor,” he said. 

“This includes how the system works, the range of services it covers, and what we aim to achieve through closer monitoring.”

The introduction of this tool marks a turning point for Cyprus’ public healthcare. While Gesy has already modernised many health processes, the AI-powered platform is expected to boost oversight and efficiency even further.

“Our software has freed us from many of the bureaucratic hurdles other health systems still face,” Panayides said. 

“Now, with this system, we’ll be able to thoroughly analyse what is being entered into the database and carry out more targeted, effective checks.”