BC Advantage - 2026 Issue 2

Diagnosing Danger: AI-Generated Diagnosis in Medicare Advantage Coding

<p>The government is targeting companies and employees for adding diagnoses that allegedly fraudulently increase Medicare Advantage (MA) plan payments (&ldquo;Medicare Advantage Provider Independent Health to Pay Up to $98 Million to Settle False Claims Act Suit,&rdquo; 2024). This practice is happening more often due to AI programs that scan documentation and suggest diagnosis codes that might have been missed. The potential liability could be serious and widespread, especially if such conduct results in higher MA risk adjustment payments.</p> <p>&nbsp;</p> <p><strong>False Claims Act...

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