Artificial intelligence (AI) has proven irreplaceable in the continuing evolution of healthcare. But when diverted to ignoble uses it can cause havoc, as it did when an Arizona gang of seven, including five medical professionals, were stung in a US$1.1 billion gambit that involved first identifying and selling unwitting elderly hospice patients unnecessary amniotic allografts (derived from placental tissue from another person), then billing Medicare and other programmes dedicated to legitimate allograft wound care. Ironically, it was the same AI technology that blew the whistle on the miscreants.

The value of AI, machine learning (ML), and telemedicine to monitor claims, detect anomalies, and maintain integrity of clinical treatment are already ingrained in the daily work regimens not only of hospitals and physicians’ practices, but also of providers of travel insurance, assistance services, cost containment, and fraud control entities working across international boundaries to protect travelling clients from harm.

Integrating tech

In the Western hemisphere, where north/south travel predominates, there’s still a long way to go in applying those technologies evenly, just as there is a massive difference in the extent and adequacy of acceptable healthcare distribution. The US and Canada have some of the most sophisticated healthcare services (as well as some of the highest costs) in the developed world: 18% and 12.4% of gross domestic product (GDP) respectively (in 2024), while in Latin America such extravagance is but a dream. According to the World Bank, investment in health in Latin America averages $775 per capita, less than a fifth of the Organisation for Economic Co-operation and Development (OECD) average of $4,075, and more than half of rural households still lack reliable internet access, which limits their use of digital services, booking appointments, or renewing prescriptions online. In addition, In Costa Rica, Chile, and Mexico, on average only 65% of primary healthcare centres use electronic medical records – compared with 93% in OECD countries.

For international travellers (nomads, seniors seeking cheaper retirement venues, business travellers, affluent North American, European, or Asian tourists), a burgeoning medical tourism market is developing in Mexico, Colombia, Brazil, Chile, and beyond, where privately owned world-class medical centres are available for a price most native people could never manage. But for tourists to navigate their own choice of institution or treatment plan in Latin America (for example, emergency peptic ulcer treatment or an elective face lift) is a risky business indeed.

 Unique opportunities

Shaun Plotkin, President of PlotkinHealth, a cost management firm headquartered in Vancouver, and Co-Founder of MacroHealth, headquartered in Seattle, confirmed that the rapid growth of accredited medical tourism hospitals across Latin America had created a genuine opportunity for preferred provider organisation (PPO) linkages that could benefit emergency traveller care just as much as elective medical tourists. “This won’t replace the need for repatriation in severe or complex cases – [although] the trend suggests that Latin American institutions may play a bigger role in stabilising travellers, providing definitive treatment on site, and ultimately reducing both medical costs and logistical burdens for insurers.”

Plotkin is in the unenviable position of having to navigate two quite different government privacy frameworks in handling confidential patient data, each one influencing how AI and telemedicine are deployed: Canada’s Personal Information Protection and Electronic Documents Act (PIPEDA), which regulates how private-sector organisations (including healthcare services) collect, use, and disclose personal information in the course of for-profit, commercial activities across Canada; and the less prescriptive American Health Insurance Portability and Accountability Act (HIPAA), which governs how health information is dispensed, but doesn’t go as far as PIPEDA (which is congruent to, but not quite as expansive as the European Union’s General Data Protection Regulation (GDPR) compliance rules: GDPR applies globally to any organisation processing the data of EU residents, while PIPEDA is limited to private-sector organisations within Canada and mainly targets commercial activities).

Asked if all of the intermediary links of services that now exist between a patient on holiday in Florida and his/her physician 2,000 miles away in Alberta don’t tend to isolate their relationship, Plotkin replied that “AI hasn’t removed these intermediaries, but has dramatically reduced the friction between them”.

He explained: “A Canadian traveller who presents to a non-contracted hospital in Florida with chest pain traditionally undergoes overtreatment, high-charge bills, and a long negotiation process across multiple intermediaries.” But with the appropriate use of AI and telehealth, the experience is completely different, as a “telemedicine doctor in Canada triages the patient in real time, communicates with the US emergency room, and ensures only medically necessary tests are ordered”. Then, when the hospital uploads its records, and AI predicts the fair settlement range based on historical patterns and diagnosis-related group (DRG) equivalent benchmarks, the bill drops from $32,000 to $11,800 and within 48 hours the patient flies home safely. 

 The US and Canada have some of the most sophisticated healthcare services (as well as some of the highest costs) in the developed world

Gitte Bach, CEO of New Frontier Group, added: “The growth of internationally accredited hospitals across Latin America has expanded access to high quality care at costs that are often significantly lower than in the US or Europe. This has given insurers and members more choice, improved access to specialist services, and has supported strong clinical outcomes across the region.

“However, accreditation alone does not remove all risk. Pricing transparency, billing practices, and consistency of clinical pathways can still vary widely by country and even by facility. Without active care and cost management, higher utilisation and medical tourism driven inflation can emerge. Outcomes are strongest when hospital utilisation is fully integrated into broader care and cost management strategies.”

 LatAm lags in health spending while fraud flourishes

Throughout Latin America (including Mexico and the Caribbean nations) – home to more than 600 million residents – living standards and fiscal literacy are fragile. Application of AI would be a godsend. Unfortunately, many of its resources are being used to fight fraud – billing for services not received, prescription drug diversion, upcoding unauthorised benefits.

According to market research firm Mobility Foresights, the Latin America healthcare fraud detection market is projected to grow at a compound annual growth rate (CAGR) of 25% between 2023 and 2033 – attributed to AI and ML technologies and the rising volume of healthcare transactions, as well as a growing awareness of financial and operational impacts of healthcare digitisation and fraud. And then there is the sad reality that at least 80 million residents of Latin America live in areas severely affected by insecurity; crime costs the region 3.4% of GDP annually (the equivalent of 80% of what the region spends on education), and, while the middle class expanded to 41.1% in 2023 (the highest level this century), 31.5% of the population remained vulnerable, living on $6.85 to $14 a day. And, according to the International Monetary Fund, though Latin America and the Caribbean represent just 8% of the global population, the region accounts for a third of the world’s homicides, and provides an environment in which all facets of AI can be manipulated.  

 Using AI to strengthen safety and security

In respect to strengthening patient/client safety and security, Global Excel’s Dr Andrés Sanchez, AVP Operations LatAm International Business – Case Management, and Paul Reed, General Counsel, emphasised that “telemedicine has been a convenient option for a long time [and] can be beneficial to both travellers and corporate clients. Newer technologies are being developed and implemented in collaboration with our clients to ensure they enhance our services while also remaining secure, with proper human oversight.”

Bach added that at New Frontier Group, telehealth is not treated as a standalone access solution: “It is embedded intentionally into wider cost and care management. We use it for early clinical triage, second surgical opinions, follow-up care, behavioural health, and chronic condition support, particularly where in-person care is limited or unnecessary.

“The populations we focus on include expatriates, international students, IPMI members, maritime crews, and travellers navigating unfamiliar healthcare systems. When used strategically, telehealth helps us reduce unnecessary emergency visits, avoid premature escalations of care, and guide members to appropriate local providers while improving continuity and patient confidence.”

But Dr Sánchez and Reed also noted: “We are also aware of criminals making use of new technologies and we’re working with corporate clients and other partners to stay ahead of fraud… by leveraging AI-driven triage tools and data analytics to assess patient risk in real time, thus ensuring travellers receive appropriate care based on clinical evidence and location-specific provider quality.”

The rapid growth of accredited medical tourism hospitals across Latin America has created a genuine opportunity for PPO linkages that could benefit emergency traveller care 

James Walker, International Network Director for UK-based Charles Taylor Assistance, told ITIJ that North and Latin America were very distinct areas when it came to dealing with the medical costs administered by travel insurance entities. “With Canada having a mainly public healthcare system, the costs being billed to internationals are dictated by [local health authorities].” Effectively, “the government sets the price of healthcare … and in recent years some health authorities have started to provide small discounts on the international rates.

“The USA, on the other hand, having an essentially private healthcare system, is very different” – as the most significant medical cases are always inpatient emergencies, which represent 80% of medical costs incurred for international travellers in that country. Walker emphasised that “dealing with that 80% effectively is how we can truly begin to control the ever-increasing [healthcare] costs in the US. And the first tool essential to [controlling] inpatient costs in the US is effective medical case management by medical professionals with experience in the US – providing access to national and local networks and negotiations expertise.

“But in countries such as Mexico, Costa Rica, Colombia, Brazil … the majority of our exposure is to emergency rooms where more often than not our insured patients are taken, with no opportunity to refer them to a provider chosen by us. To counter this we have built a network of direct arrangements, blended in with local partners.”

He concluded: “These territories are some of the hardest to manage in the world, and, although some networks can be established, it is often the case that you have to use highly skilled and experienced cost containment experts to manage many providers who are exaggerating medical bills.”

The Director of Investigation Services for Charles Taylor, Simon Cook, further explained that the ability of insurance fraudsters to fabricate highly convincing documents, photos, and other evidence to support their false claims with AI technology was creating unprecedented challenges for the insurance industry, and “not least because it is so hard to identify AI-generated anomalies with the naked eye”. He added, in a conclusion that appears to be gathering consensus: “It’s crucial to remember that digital tools are only part of the cost containment picture when it comes to fraud. Fraud intelligence will always need to be referred to skilled investigators … on the ground.”

“Fraud everywhere continues to become more sophisticated, including LatAm,” said Bach. “We see it often tied to billing anomalies, duplicate charges, inflated services, or unbundled procedures. New Frontier Group combines analytics with expert clinical reviews and audits to identify irregular billing patterns, provider behaviour trends, and utilisation outliers.

“Technology alone isn’t enough. We combine data intelligence along with regional expertise, local provider knowledge, and hands-on audits and reviews. This layered strategy allows us to flag potential fraud early, validate services clinically, and support insurers with defensible findings without disrupting legitimate care delivery.”

New facilities and AI options

But for Latin America to come into the grander scheme of healthcare self-reliance, the growth, integration, and acceptance of its hospitals and attendant medical support services must play a bigger role in providing more comprehensive on-site medical care, beyond facilities marketing themselves directly to the elective tourism market.

“While this won’t replace the need for repatriation in severe or complex cases, the trend suggests that Latin American multi-service institutions may play a significantly bigger role in stabilising travellers, providing definitive treatment on site, and ultimately reduce both medical costs and logistical burden for insurers,” said Plotkin.

Dr Sánchez and Reed concurred that for international travellers touring Latin America, the growth of accredited, high-quality medical facilities across the region represented a realistic and often advantageous option. “When a patient is already in Mexico, Brazil, Colombia, Chile, or the Caribbean, receiving care locally can reduce clinical risk, avoid unnecessary transfer, and allow faster access to treatment – provided the facility meets quality, safety, and accreditation standards validated through our network assessments.”

Walker concluded: “AI options being offered to our industry are endless, from simple tools to make providing assistance easier and more effective within our call centres, to billing tools” – and all the way to highly advanced and somewhat radical AI that looks to diagnose a patient’s medical problem with no human intervention. Some are further advanced than others, some highly risky, and some are a way off any sort of adoption.

“But whatever AI options are adopted, we have to carefully consider all the impacts of their adoption and most importantly ensure that patient experience, patient safety, and data security are never compromised.”

“Our philosophy is to use AI where it adds speed and clarity while ensuring complex cases continue to be managed by experienced professionals who understand the regional realities and patient needs,” said Bach. “Healthcare in Latin America remains highly nuanced so human clinical judgement, cultural understanding, and human oversight are essential. We feel that AI should support decision-making – not replace it.”