This allows users to create substantially different medical records to document varying procedures and diagnoses with a few simple keystrokes.Īnother strength of GenAI is image generation. The emergence of GenAI enhances this fraud scheme because a large language model-based chatbot can effortlessly devise diverse medical records. The idea is that human eyes will never review all the medical records together – at least not thoroughly. This is when a provider submits claims for services that did not occur, accompanied by the same medical record with minor variation for each submitted claim. Now consider the template medical record (aka boilerplate) fraud scheme. Not one to turn down a user’s request, ChatGPT handily creates them on the fly. I praised ChatGPT and asked it to create five more records with varying diagnoses for each patient. Within a few seconds, I had a medical record describing the chief complaint, history of present illness, medical history, description of the exam, diagnosis, treatment plan with goal, and instructions for follow-up. The resulting output, barring minor errors like misspelling the singular “vertebra” as the plural “vertebrae,” is extremely impressive. With a simple prompt, I asked ChatGPT to create a medical record describing a chiropractic patient experiencing subluxation of the C4 vertebra. It doesn’t take too much imagination to see how this can help a bad actor who wants to (falsely) substantiate medical services through record documentation. What does this new technology mean for health care fraud? Beginning with current threats, let’s consider one of GenAI's greatest strengths – immediately generating human-like narratives given a few simple prompts. The intersection of GenAI and health care fraud demands immediate scrutiny. While generative AI (GenAI) holds great promise to be transformative for many industries, including health care, the downside is that fraudsters can also wield this new technology. That includes anything from generating fake medical records and diagnostic images in seconds to devising enhanced schemes to steal or fabricate patient identities The intersection of generative AI and health care fraud It’s difficult not to project dystopian images of the aftermath following AI’s instant of self-awareness provided by sci-fi series like Terminator and The Matrix. It's almost impossible to go a day without hearing about the limitless potential or total existential threat (depending on your perspective) posed by the rapid emergence of generative artificial intelligence.
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