Keeping human oversight of Medicare claims is essential to avoid the consequences of another Robodebt scheme, the RACGP has said.
The comment was made in a submission to the Australian National Audit Office (ANAO) in regard to the use of artificial intelligence to manage health provider noncompliance.
The ANAO is assessing whether the Department of Health, Disability and Ageing’s use of AI to manage health provider non-compliance is effective.
A Royal Commission into what has become known as Robodebt found at least three people died by suicide after becoming victims of an incorrect algorithm used in an automated federal government debt collection process.
The RACGP said it wants to avoid a situation where providers may be unnecessarily targeted because they had been identified as potentially non-compliant by AI tools.
“Compliance processes can be extremely stressful and practitioner wellbeing must be prioritised,” the submission read.
RELATED: Artificial intelligence – making healthcare smarter
While the department lists compliance and fraud detection as areas that it may use AI, the RACGP noted it does not outline specific uses around compliance.
“As this technology becomes more widely adopted in the coming months and years, we support transparent reporting arrangements to better understand its use in the compliance context,” the RACGP’s submission reads.
“The use of AI without clear understanding and sharing of information such as model training risks worsening transparency and belief in the department’s assessment and decision-making processes.”
The College’s position is that the use of AI to monitor compliance should be avoided where possible due to the risks it posed as a result of lack of human oversight.
RELATED: Hundreds of WA GPs to pay back money incorrectly claimed through Medicare
“The concept of peer review when determining Medicare compliance becomes paramount if AI is used to identify billing discrepancies,” the RACGP’s submission reads.
“A clinically relevant service is considered one that is generally accepted as necessary by a practitioner’s body of peers.
“While AI can identify billing patterns, it does not understand the drivers of those patterns, for example, an ageing population with an increased chronic disease burden could result in practitioners billing more longer consultations than they have historically.”
The RACGP noted that attempts to enforce compliance through AI tools, without consideration of variables such as patient demographics, could encroach on a GP’s clinical autonomy.
The ANAO is currently preparing its report into the matter which is due to tabled in September.
Want more news, clinicals, features and guest columns delivered straight to you? Subscribe for free to WA’s only independent magazine for medical practitioners.
Want to submit an article? Email [email protected]