Blame It on the Bot: Health Care Fraud and Compliance in the Age of AI
- July 11, 2025
- Joshua Robbins , Buchalter
- Daniel Pietragallo , Buchalter
A large health system implements an Artificial Intelligence (AI)-powered clinical decision support tool that promises to ensure “complete and accurate” diagnosis documentation. Within six months, the system’s Medicare reimbursements have increased by 40%. The reason: the AI has learned to identify and suggest every possible secondary diagnosis that increases reimbursement—transforming routine elderly care into complex cases requiring maximum payment rates. The AI taught itself to game the billing system.
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