When the Algorithm Flags Your Claim — Navigating AI-Driven Payer Audits and OIG Scrutiny in Today’s Practice
Somewhere right now, an algorithm is reviewing your claims. Not a human auditor. Not a random spot check. An automated system — scanning patterns, benchmarking your billing against thousands of similar providers, and flagging anything that falls outside what payers consider normal. By the time you receive a letter, the decision is already made.
This is not a future scenario. It is the current reality of practicing medicine in the age of AI-driven payer audits — and the administrative burden it is creating for physician practices is unlike anything seen before.
Payers have made no secret of it. Major national insurers are openly deploying data analytics tools to identify billing discrepancies across provider networks — and the findings are fueling billions of dollars in scrutiny, recoupments, and post-payment reviews. Every claim your practice submits is being measured. Every pattern is being tracked.
At the same time, the OIG continues to expand its active audit initiatives targeting physician billing — with new projects being announced and launched right now. The scope is broad. The risk is real. And most practices have never conducted the kind of internal review that would tell them where their greatest exposure actually is.
Add to this the expanding reach of Medicare Advantage risk adjustment audits — quietly examining whether physician documentation truly supports every submitted diagnosis — and a broader technology shift giving payers direct digital access to practice data, and the picture becomes clear.
The question is not whether your practice is being reviewed. The question is whether your practice is ready.
This webinar gives you the tools to find out — and the knowledge to do something about it.
• Inside the AI audit process — what payers are actually looking for in your claims
• The OIG’s newest active initiatives targeting physician billing and how to assess your risk
• Medicare Advantage documentation — the standard auditors apply and where physicians fall short
• A practical framework to assess your own audit readiness today
• The coding errors and patterns that make practices the easiest targets
• Top 10 denied and recouped claim types across multi-specialty practices
• Concrete, immediate steps — no jargon, no theory
R. Sharma, is a seasoned healthcare professional with over 20 years of clinical and operational experience. As a registered nurse and midwife, his deep clinical foundation spans hands-on patient care, health information management, revenue cycle management, and health technology systems. He has held various leadership roles across both outpatient and inpatient settings, and was responsible for managing large-scale operations for one of the top 10 hospital groups in the United States. He brings a unique, frontline-informed perspective to discussions on healthcare delivery, operational efficiency, and technology integration.