Artificial intelligence programs may inflate medical bills… and governance is a necessity, not an option

Chairman of the Board of Directors and CEO of Tadawi Healthcare Group, Marwan Ibrahim Haji Nasser, warned of disturbing technical practices that may accompany the expansion of the use of artificial intelligence programs within health institutions in the region, stressing that the absence of clear regulatory frameworks may lead to unjustified inflation of treatment bills and insurance claims.
He explained that artificial intelligence has now become a major part of the management and operation of health systems globally, especially in the areas of medical records, billing and revenue management, noting that these technologies hold great opportunities to improve the quality of care and speed up procedures, but at the same time they entail risks if misused.
He pointed out that some smart systems designed to maximize documentation may include additional tests, examinations, or diagnostic procedures within the course of treatment, without always being based on a precise medical need, which is reflected in the final bill and raises the cost of treatment without clear clinical justification.
He added that the challenge does not lie in the technology itself, but in the mechanisms of its use, explaining that algorithms are often designed to achieve operational or financial goals, which may turn into a systematic flaw if these systems are not subject to careful regulatory review and specialized medical human supervision.
In this context, he pointed out that a number of international experiences have shown that artificial intelligence systems that were originally developed to improve efficiency and revenues began to reveal, when applied to real data, abnormal patterns in medical billing and coding, which confirms the need for a governance framework that precedes the widespread spread of these technologies.

He stressed the need for artificial intelligence to remain a tool to improve the quality of health care and protect the patient, not an invisible means to raise revenues, stressing that transparency in this field represents a moral responsibility before it is an administrative requirement.

He called on the health and regulatory authorities in the country to build a clear institutional partnership between care providers, technology companies, and regulators, to develop proactive legislation that regulates the use of artificial intelligence in billing and management of treatment paths, while ensuring the presence of mandatory human medical oversight of the outputs of these systems.

At the conclusion of his statement, he stressed that the future of artificial intelligence in healthcare should not be measured by the speed of algorithms or the volume of revenues, but rather by its ability to enhance trust, protect the patient, and ensure the sustainability of the health system as a whole.