I recently provided insight for a Modern Healthcare article that examines the Department of Justice’s (DOJ) increased healthcare fraud enforcement efforts and growing use of artificial intelligence (AI) and data analytics in civil investigations. While whistleblower complaints continue to account for a substantial share of False Claims Act recoveries, the article highlights how enforcement agencies are increasingly using technology to identify billing outliers and support government-initiated investigations.
“The government isn’t sitting and waiting on whistleblowers to find fraud cases,” I explained in the article. “Expect this trend to continue when you layer on the administration pushing the use of AI, predictive analytics and machine learning to flag outliers in billing and coding as prosecutors look to conserve government resources.”
I added, “The DOJ has a significant pipeline of False Claims Act cases, maybe the most in history.”
The full article, “Providers on defense as feds ramp up fraud enforcement, deploy AI,” was published by Modern Healthcare on March 2 and is available online (subscription required).
For further examination of the healthcare fraud landscape, access Bass, Berry & Sims’ recently released 14th annual Healthcare Fraud & Abuse Review that provides a comprehensive analysis of 2025 enforcement developments, significant court decisions and settlements affecting the healthcare industry. Access the Review here.