Compliance Perspectives

By Adam Turteltaub There’s always a “but” when it comes to AI. It has great potential, but there’s always the risk of bad things happening. In the case of the False Claims Act and healthcare, that’s very much the case. In a recent article for Compliance Today – “AI and the False Claims Act: Navigating compliance in the age of automation” -- Phoebe Roth and Colton Kopcik of Day Pitney warn that the same “but” applies to medical coding. AI and coding seem to be a match made in heaven. There is enormous potential for ensuring that bills get processed quickly and all the proper charges are made.  But (of course) plenty of risks come with it. First and foremost, a lack of human oversight can lead small errors to quickly multiply, especially if the AI model was trained on biased historical data or follows patterns of mis-billing. False claims can then can quickly spiral out of control, leading to expensive refunds and settlements. Other areas of risk include telehealth and remote care fraud, especially at a ti