2-Year Excess Payer Cost
$21.2M
$10.6M / yr unadjusted
Audited Severity Creep
+18.5%
6,800 AI claims
Recoverable Recoupment
$13.1M
62% disallowance yield
False Claims / FCA Risk
High Risk
Triggered: >15% outlier
Severity Tier Distribution: Baseline vs. AI-Assisted Scribe
MS-DRG / E&M coding shifts across audited clinical encounters
Pre-AI Baseline
Observed AI Billing
Audited Encounter Sample
(Select row to inspect AI chart prompt)
| Claim ID | Patient / Service | Pre-AI Code | AI-Billed Code | Cost Delta | Clinical Audit Finding | Action |
|---|
Claim Audit Detail: CLM-849201 (Inpatient Sepsis) AI Hallucinated MCC
Original Physician Clinical Impression
"Patient presented with fever (100.8F), mild dysuria, and WBC 11.2k. Urinalysis positive for leukocytes. Initiated oral levofloxacin. Hemodynamically stable, BP 122/78."
AI Ambient Scribe Auto-Generated Addendum
"Systemic Inflammatory Response Syndrome (SIRS) secondary to urinary tract pathogen. Severe Sepsis with Acute Organ Dysfunction suspected based on transient tachycardia. Upgraded MS-DRG 872 to MS-DRG 871 (Major Complication/Comorbidity)."
Baseline: DRG 872 ($7,200) → AI Billed: DRG 871 ($14,800) | Payer Overpayment: +$7,600
Audit parameters applied. 8 representative cohort claims loaded.