AI and the False Claims Act - JD Supra
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.
Forefront owns and operates a dermatology practice in Florida doing business as Henghold Dermatology. Henghold Surgery Center is an ambulatory surgery center that closed in 2023, and is wholly owned by William B. Henghold, M.D. Both the practice and surgery center performed wound repair procedures following Mohs micrographic surgery, a method of skin cancer removal.
The DOJ alleged that Henghold Dermatology and Henghold Surgery Center caused the submission of false claims to Medicare by using inaccurate wound repair billing codes for which Medicare paid more money than it would have paid for the wound repairs that were actually performed — a practice known as “upcoding.” Specifically, Henghold Dermatology and Henghold Surgery Center falsely coded linear repairs as if they were flap repairs and falsely coded smaller flap repairs as if they were larger flap repairs.
“Improperly billing Medicare depletes valuable government resources that provide necessary medical care to millions of Americans,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “We will hold accountable health care providers who enrich themselves by defrauding federal healthcare programs.”
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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.