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AI is Proving to be an Advantage for Whistleblowers in Protection Against Fraud

Posted  May 14, 2024

The debates about the potential advantages and dangers of artificial intelligence (“AI”) rage, but for whistleblowers and their attorneys there are some notable advantages.

To help identify and build a strong case, AI can provide efficient analysis of large amounts of data, identifying connections and deviations that might suggest wrongdoing. These pattern analyses provide utility not only for internal whistleblowers within corporations and other workplaces, but also for outsiders who can synthesize mass amounts of data which can be increasingly accessed on the dark web and openly in the public domain.

AI can not only organize evidence and compile legal research swiftly, but this powerful tool can contribute to whistleblower safety by gauging risks, assessing likely outcomes and to better protect whistleblowers’ identities. Certain AI systems can scan data for names or dates that might identify the whistleblower and to further anonymize the data. Blockchain and encryption allow for safe communication by using complex algorithms to make data unreadable to anyone who does not have the decryption key.

The healthcare industry highlights the potential beneficial impacts of AI.  Forbes Advisor reports that health care insurance fraud, including Medicare and Medicaid fraud, topped the most costly category of insurance fraud in 2024, costing consumers approximately $105 billion annually.  Of the more than $2.68 billion in False Claims Act settlements and judgments reported by the Department of Justice in 2023, over $1.8 billion related to healthcare fraud involving “managed care providers, hospitals, pharmacies, laboratories, long-term acute care facilities and physicians.” AI algorithms can be used to identify patterns of overbilling and fraudulent coding practices across the industry. For instance, AI machine learning models can analyze vast numbers of patient records to identify patterns of exaggerated diagnoses and other inconsistencies, which are leading to recoveries of millions of dollars in Medicare and Medicaid fraud lawsuits filed by whistleblowers annually.

These settlements and judgments will only grow as more whistleblowers and their counsel incorporate the use of AI into their practices and as technical capability and capacity issues relating to AI improve.

Of course, these same AI use-cases extend to other lines of insurance, including life insurance fraud and property and casualty insurance fraud, which resulted in $74.7 billion and $45 billion in consumer costs respectively in 2024.  And beyond to all industry sectors from finance, and cybersecurity to government contracting.

The DOJ promoted the use of AI recently. On May 5th, U.S. Deputy Attorney General Lisa Monaco remarked at a cybersecurity conference that the DOJ uses AI to triage the more than one million tips the FBI receives every year. She added that they used AI in “some of [their] most important and significant investigations, including the Jan. 6 investigation.” While Monaco also expressed her awareness of potential dangers, specifically in regard to elections where “malicious actors” can spread misinformation and cause “chaos and distrust” in the system, she confidently stated that DOJ will continue to build “guardrails” around AI so that they can harness its great benefits and avoid great threats.

Law firms representing whistleblowers and the government are also regularly leveraging artificial intelligence during the discovery phase of legal matters, to help prioritize for review the voluminous information they receive, expediting key information and data points and becoming more efficient as a result. Regardless of the industry or sector, AI has proven it is here to stay and its potential benefits to be embraced.

If you have information relating to potential government contract fraud or a False Claims Act violation and would like to speak to a member of the Constantine Cannon whistleblower lawyer team, please don’t hesitate to contact us for a free and confidential consultation.