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Vol. 8 No. 16 (2026): Julio - Diciembre
Published 2026-07-31
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Artículos de reflexión

Artificial intelligence and fraud oversight in social security systems

DOI: https://doi.org/10.22490/26655489.11666
Nermis Andujar Troncoso Tesorería de la Seguridad Social de la República Dominicana
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Historically, the health component of social security systems has been a target of unlawful practices associated with fraud. Although fraudsters employ various methods, one of the most common consists of gaining access to the social protection provided by a financing scheme that does not correspond to the alleged beneficiary’s socioeconomic, contribution, or contributory status. This inequality creates a financial deficit in the revenues collected at the time of distribution, seriously affecting the system’s financial balance of the system and its legitimate beneficiaries. This article evaluates improvements, methods, and opportunities within the operational processes of social security systems, aiming to strengthen fraud prevention and timely detection through the appropriate implementation of the resources offered by information technologies. The central premise is that fraud operates as a highly effective and recurrent mechanism of evasion and avoidance in the face of traditional supervision and control systems, which, although effective in the past, have become obsolete in a digital environment marked by constant challenges. In this context, artificial intelligence emerges as a necessary tool to restore balance in the face of opportunistic gaps that leave these systems exposed. The methodology employed is primarily qualitative and includes approaches, analyses, and case studies, complemented by some specific quantitative data.

keywords: Artificial intelligence, automated supervision, digital governance, fraud, public administration, social security
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How to Cite

Andujar Troncoso, N. (2026). Artificial intelligence and fraud oversight in social security systems. Análisis Jurídico Político, 8(16), 135-154. https://doi.org/10.22490/26655489.11666
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