Using Agentic AI for Healthcare Compliance

Every industry has been impacted by AI transformation projects and for healthcare, the AI transformative possibilities range from agentic diagnostics and treatment to greater operational efficiencies and regulatory compliance support. With current research projecting that “artificial intelligence in healthcare market size was estimated at USD 36.67 billion in 2025 and is projected to reach USD 505.59 billion by 2033, growing at a CAGR of 38.90% from 2026 to 2033”, it should come at no surprise that a significant portion of this spend is focused on dealing with the ongoing challenge of keeping up with regulations and compliance requirements.

The impact of noncompliance

Healthcare compliance requirements are numerous and seemingly ever-changing. Healthcare administrators managing complex, evolving regulations face numerous challenges including:

• Cybersecurity and data breaches: Keeping patient information safe from ransomware and other attacks is an ongoing challenge, especially with more remote work and more vendors connecting to your systems.
• Regulatory complexity and frequent changes: Requirements keep shifting across federal and state rules (including laws like the False Claims Act and Stark Law), making it hard to stay current and apply the latest guidance consistently.
• Staffing and time constraints: Many teams don’t have enough compliance staff, which can lead to burnout and makes it harder to monitor risk, follow up on issues, and keep documentation in order.
• Billing and coding risk: Documentation gaps or coding mistakes—such as billing at a higher level than supported or billing for services that aren’t well supported—can result in denials, repayments, and significant penalties.
• AI-related compliance risk: As more AI tools are used in operations and clinical support, new questions come up around safety, oversight, documentation, and what regulators will expect.
• Telemedicine and remote care: Virtual visits and remote services still need to meet privacy, security, and licensing requirements, including how patient information is accessed, stored, and shared.
• Third-party/vendor management: Business associates and vendors often need access to systems or data, so you need clear agreements, controls, and ongoing oversight to reduce privacy and security risk.

The business impact in revenue and reputation costs for violations can be catastrophic with fines and penalties that range from $100 to $50,000 per violation, with up to $1.5M annual maximums for serious or willful neglect as well as the potential for patient lawsuits or in extreme cases, criminal investigations and prison time. But it is the loss of trust in the healthcare provider that has the most long-standing negative impact for noncompliance that makes derisking compliance issues a priority for every healthcare organization. Trust erosion alone has been reported to lead to a 6.7% patient churn rate, with lost patients creating lasting revenue gaps.

Agentic AI derisks healthcare compliance issues

Effective use of Agentic AI can redefine how healthcare organizations derisk compliance requirements by shifting from passive, reactive monitoring to active, autonomous governance and remediation. Rather than merely detecting any of the seven compliance challenges described above, Agentic AI can be deployed to take a proactive approach for fixing, updating, and securing potential issues in real-time. The use of a Data Intelligence Cloud for AI can provide a business-led approach to AI transformation

By moving from manual, after-the-fact reviews to automated, continuous monitoring, healthcare organizations can streamline audit prep, reduce regulatory risk, and prevent costly billing and documentation issues before submission. Specific key areas for derisking healthcare compliance issues include:

• Continuous controls monitoring: AI can continuously review EHR activity and key workflows to identify potential HIPAA/privacy issues, access anomalies, and documentation gaps in near real time—supporting earlier intervention and remediation.
• Audit readiness and evidence management: AI can help standardize and organize control evidence (logs, attestations, policy acknowledgements, and workflow artifacts), improving traceability and reducing scramble during surveys and audits (e.g., NCQA, The Joint Commission).
• Regulatory intelligence and policy alignment: AI can track updates to laws and accreditation standards, route changes to the right owners, and help validate that policies, procedures, training, and controls stay aligned as requirements evolve.
• Risk-based surveillance and prioritization: Using trends and known risk indicators, AI can surface where compliance breakdowns are most likely (e.g., unusual billing patterns, outlier documentation, higher-risk vendors) so leaders can focus reviews and corrective action where it matters most.
• Privacy and security oversight: AI can strengthen oversight of protected health information by monitoring access for exceptions, supporting least-privilege reviews, and improving the defensibility of access controls and incident response workflows.

The good news is that you won’t have to wait months or even years to realize the benefits of a data intelligence cloud. New developments in open-source, zero-code SaaS platforms mean that legacy system modernization projects can be tackled immediately to reduce dependencies on proprietary systems, limit end user computing tool spread as well as the costs of dedicated tools and resources.

Delivering on the promise of agentic AI in healthcare

UBIX is revolutionizing the way healthcare organizations approach data and AI to derisk compliance issues with a Data Intelligence Cloud for AI. ​ Its no-code, risk-free solution empowers organizations to harness the power of AI on their existing infrastructure, driving efficiency, innovation, and compliance. ​ With UBIX, companies can transform their operations and achieve data democratization in record time.

Our innovative, secure, and flexible patented no-code platform leverages to power of GenAI, Reinforcement Learning and Agentic AI to enhance its capabilities and transform data into usable information accessible by the average person starts with ensuring you have the right data to the right person at the right time in the right format. With an architecture that is designed to adapt to the varying demands of organization, allowing them to scale up or down based on their specific requirements and delivering value in days not weeks or months.

Learning how GenAI and emerging advancements like Reinforcement Learning and Agentic AI can deliver on the promise of a data intelligence cloud to derisk healthcare compliance has never been easier. Download our free eBook titled “Agentic AI and the Power of Action Agents” to help better understand the nuances of emerging AI concepts and technologies and offer a set of best practices for consideration to ensure digital transformation and business-led AI success. Or if you can spare 22 minutes for a mini–AI Readiness Workshop, you can contact one of our AI experts today.