PUSHING
BOUNDARIES
The Unlicensed Practitioner in Your Chart:
Why We Must Regulate AI Before It Regulates Us
by Thomas S. Higgins, Jr., MD, MSPH, MBA
The practice of medicine has always been an art and a science. It relies on the subtle intuition of a seasoned clinician, the tactile feedback of a surgeon’ s hands, and the empathetic connection that happens in an exam room.
But today, a third player has entered that room: Artificial Intelligence.
As we enter 2026, we are no longer talking about the future of AI. It is already here. It is reading your radiology scans, drafting your chart notes and, most concerningly, deciding whether your patient gets paid for their surgery.
While AI holds incredible promise to reduce our administrative
burden, it currently poses two existential threats to our profession that we must address immediately: Algorithmic Denials and Liability Traps.
The Denial Machine
If you have noticed a spike in bizarre claim denials recently, you are not imagining it. You are likely fighting a computer.
Major national payers are increasingly deploying predictive algorithms( such as the“ nH Predict” tool currently under federal scrutiny) to bulk-review claims. These“ black box” systems digest thousands of patient records and output a probability score. If the computer says a patient’ s length of stay should be three days, and you keep them for five because of unstable vitals, the claim is often automatically denied
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