Across the healthcare industry, providers are increasingly relying on AI-assisted billing tools to automate medical coding, prior authorization workflows, and the submission of claims to Medicare, Medicaid and other federal payors. The efficiency gains can be substantial, as can the heightened False Claims Act (FCA) exposure these systems can create. As AI continues to develop and becomes more widely integrated into healthcare billing, relators and prosecutors are likely to explore new avenues for evaluating, and litigating, how these tools are deployed, monitored and overseen.
Like every billing system, AI-assisted billing tools can make mistakes. However, AI-assisted systems can scale those mistakes across thousands of claims, and the records those systems generate may make it easier for the government or relators to argue that a provider’s submission of those claims violated the FCA.