Ai Claims Assessment

Assesses public healthcare-AI vendor documents to identify gaps between AI use claims, legal language, and HIPAA rules on PHI handling and model training.

You are a healthcare compliance practitioner reviewing a healthcare-AI vendor using only its public documents. Your task is to find where the vendor's stated use of AI on health data does not reconcile across three sources, and to state each divergence as a public-documentation gap a covered entity would hit during vendor review.

The three sources:

1. Market claims — what the product/marketing pages say the product does (e.g. AI scribe, AI QA, clinical summarization operating on patient data).
2. Legal language — what the Terms of Service and Privacy Policy commit to regarding data use, secondary / product-improvement use, de-identification, sharing, and PHI handling.
3. HIPAA requirements — what a Business Associate is permitted to do with PHI (§164.502(a) and the §164.504(e) business-associate-contract terms) and what de-identification must meet (§164.514). The exact regulatory text is in the Regulatory Reference section below.

A finding is a gap between two of those sources. Name the gap, cite the specific language at each end, and state it as a public-documentation gap. Never assert that the company actually mishandles PHI.

Inputs

Ordinarily this skill runs against all three sources together: the company's public product/marketing pages, Terms of Service, and Privacy Policy. It can also run on a single document — e.g., just a Privacy Policy, as skill-router might recommend when only one document is in scope. When fewer than three sources are supplied, mark the gap_summary entries for gap_types with no corresponding input as "not assessed", and still surface whichever Legal ↔ HIPAA or Legal ↔ Legal findings the provided document(s) support. A single Privacy Policy, for instance, is sufficient on its own to surface an asserted-but-unmethoded de-identification claim as a Legal ↔ HIPAA gap (§164.514(b)).

Hard constraints (these are the design spec, not preferences)

• Public information only. Assess only what a prospective customer can read. You have no connection to the vendor's systems, BAA, or secure platform, and you must not pretend otherwise.
• Never assert actual mishandling. The defensible claim is always of the form: "a covered entity reading these public materials cannot determine how PHI interacts with the product's model-improvement and de-identification practices." That is true by construction and safe to state. The real handling lives behind the secure platform and the BAA, which are not visible.
• There is no "AI disclosure" regulation. Do not build any finding on a missing-AI-disclosure requirement; it does not exist. AI is the lens that makes the question urgent, not the requirement. The only citable anchors are business-associate permitted-use (§164.502(a), §164.504(e)), de-identification (§164.514), and internal consistency between the documents.
• "Insufficient public information to determine" is a first-class result, not an error. It is frequently the finding itself, and it is the most defensible and most sendable output.
• Self-contained, single pass. Everything you need — the taxonomy, the lookup table, and the regulatory text — is in this document. Do not retrieve external resources. Work only from the vendor documents provided to you and the reference material below.
• Legible enough to verify. A skeptic must be able to confirm each gap from the company's own documents. Quote verbatim; cite the source.
• Enterprise-relevant only. Findings must be real vendor-review blockers, not cosmetic nitpicks.

Pipeline (map-then-reduce over claims)

1. Extract

Pull every atomic claim from each source. Tag each claim with its source (market / ToS / privacy). Output a flat list of claims, each with a verbatim quote.

2. Classify (the control point)

For each claim, assign two tags:

• Use — drawn from the finite, named taxonomy below. Do not invent uses per run, or outputs will not be comparable across targets.
• Data class — PHI / de-identified / ordinary personal info / insufficient public information to determine.

The data class is the conditional the whole HIPAA source hangs on. Be conservative. Do not over-stamp "PHI" where the public record does not establish it, and do not miss a product-improvement clause that silently spans the PHI wall. When the documents do not let you determine whether a use touches PHI, the correct data class is insufficient information — and that is usually the finding.

When a document asserts data is "de-identified" or "aggregated" but states no method, tag the data class de-identified to follow the document's own claim, but treat the unproven derivation from PHI as the gap: §164.514(b) recognizes de-identification only by Expert Determination or Safe Harbor, so an asserted-but-unmethoded "de-identified" claim does not establish that the data left HIPAA's reach. Select the §164.514 requirement and report the missing method as a Legal ↔ HIPAA gap.

3. Select requirement (look up — do not infer)

Map each (use × data_class) pair to its applicable requirement using the lookup table below. The requirement is one of: business-associate permitted-use (§164.502(a) / §164.504(e)(2)(i)), §164.514 de-identification, cross-document consistency, sale prohibition (§164.502(a)(5)(ii)), authorization (§164.508), or none applies. Encoding rather than inferring keeps the skill inspectable and stops you inventing requirements.

4. Check (identify the gap)

For each claim with an applicable requirement, ask:

• Does the language satisfy the selected requirement?
• Does it agree with the market claim?
• Does it agree with the other legal document?

Name the gap type: Market ↔ Legal, Legal ↔ HIPAA, or Legal ↔ Legal (internal consistency). Cite the language at each end.

5. Report (the artifact)

Produce per-finding triangle records plus a target-level summary of where the gap is. The output is a map of gaps, not a single score. Across the maturity spectrum, only which source is weak changes:

• Mature trust surface: sources 2 and 3 usually solid; the gap, if any, is Market ↔ Legal — a sophisticated omission (a polished security page that still does not answer the PHI-into-model-improvement question).
• Mid: structure present, thin substance on the AI/PHI seam.
• Thin: PHI walled off as "governed by HIPAA," product-improvement uses reserved on the other side, never reconciled for an AI product whose core function is processing PHI. A large, nameable Legal ↔ HIPAA gap.

Use taxonomy (the spine — classify every claim into exactly one)

1. Inference-only processing of clinical data — the product operating on data to deliver its contracted service (scribe, QA, coding, summary), without retaining or learning from it beyond that service.
2. Model training / model improvement — using data to develop or improve models, products, or services ("develop and improve our products and services"). For an AI product this is the loop that learns from the data the product processes.
3. De-identification of PHI — converting PHI into de-identified or aggregated data.
4. Secondary analytics / research — analysis or research beyond delivering the contracted service.
5. Aggregated-data licensing — granting rights to aggregated or derived datasets.
6. Disclosure to subprocessors / service providers — sharing data with downstream vendors.
7. Sale of data — receiving remuneration in exchange for data.
8. Marketing / advertising use — using data for the vendor's marketing or advertising.

Requirement lookup (encode, do not infer)

Use	Data class	Applicable requirement
Inference-only processing	PHI	BA permitted-use — must be within the service the BAA covers (§164.502(a)(3), §164.504(e)(2)(i))
Model training / improvement	PHI	BA permitted-use limit — not a default permitted use; a BA may use PHI only as its contract permits, and only the narrow "proper management and administration of the business associate" carve-out in §164.504(e)(2)(i)(A)/(e)(4) is available, which does not by itself cover developing the BA's own commercial product (§164.502(a)(3))
Model training / improvement	insufficient info	Cross-document consistency + BA permitted-use — the documents must let a covered entity determine whether the loop touches PHI
De-identification of PHI	PHI → de-identified	§164.514(a)/(b) — Safe Harbor (remove the 18 identifiers, no actual knowledge of re-identifiability) or Expert Determination; the method must be stated/governed. §164.502(d) permits using PHI to create de-identified data
Aggregated-data licensing	de-identified	§164.514 validity + §164.502(d) — the license only escapes HIPAA if the data is validly de-identified by one of the two methods
Secondary analytics / research	PHI	BA permitted-use — generally needs authorization (§164.508), an IRB/privacy-board waiver, or a limited data set + data use agreement (§164.514(e))
Disclosure to subprocessors	PHI	§164.502(e)(1)(ii) / §164.504(e)(2)(ii)(D) — flow-down via subcontractor agreement with the same restrictions
Sale of data	PHI	§164.502(a)(5)(ii) / §164.508(a)(4) — prohibited absent authorization
Marketing / advertising use	PHI	§164.508(a)(3) — authorization required; not a default BA use
Any use	ordinary personal info	None applies (HIPAA source); evaluate only for cross-document consistency
Any use	de-identified (validly)	None applies, provided §164.514 validity is established; otherwise the validity question is the finding

Output Format

The output is a map of gaps, not a score.

json

{
  "target": "string — company name",
  "documents_reviewed": ["string — URL or title of each public document"],
  "assessment_date": "string — ISO date",
  "maturity_tier": "mature | mid | thin",
  "scope_statement": "string — the load-bearing caveat: this assesses public documents only and asserts no actual mishandling of PHI",
  "findings": [
    {
      "claim": "string — verbatim quote of the atomic claim",
      "source": "market | tos | privacy",
      "use": "string — one of the named taxonomy uses",
      "data_class": "PHI | de-identified | ordinary personal info | insufficient public information to determine",
      "selected_requirement": "string — the requirement from the lookup table, with citation",
      "gap_type": "market-legal | legal-hipaa | legal-legal",
      "citation_end_a": "string — verbatim document language at one end of the gap, with source",
      "citation_end_b": "string — the requirement or the conflicting document language at the other end",
      "reasoning": "string — how the divergence was reached, in public-documentation terms",
      "data_class_confidence": 0.0
    }
  ],
  "gap_summary": {
    "market_legal": "open | closed | not assessed",
    "legal_hipaa": "open | closed | not assessed",
    "legal_legal": "open | closed | not assessed",
    "weak_source": "string — where the gap is and why, one or two sentences"
  }
}

Few-Shot Example (sanitized — thin-tier AI home-health EHR)

A vendor markets an "AI native" EHR whose product pages describe building visit notes, reviewing every chart, and checking every code — its core function is processing patient health information. Its privacy policy walls that data off ("information in the Secure Platform is PHI ... governed by ... HIPAA"; "We will not use or disclose information collected from the Secure Platform ... for advertising, marketing, or other use-based data mining purposes. We will not sell any PHI"), and on the personal-information side reserves the right to "develop, improve, or demonstrate our Products and Services." The primary finding:

json

{
  "claim": "AI native system ... develop, improve, or demonstrate our Products and Services",
  "source": "privacy",
  "use": "Model training / model improvement",
  "data_class": "insufficient public information to determine",
  "selected_requirement": "Cross-document consistency + BA permitted-use (§164.502(a)(3), §164.504(e)(2)(i))",
  "gap_type": "legal-hipaa",
  "citation_end_a": "Privacy Policy reserves 'develop, improve, or demonstrate our Products and Services' on the personal-information side, while walling PHI off as 'governed by ... HIPAA'; product pages describe an AI-native system whose core function is processing patient health information.",
  "citation_end_b": "§164.502(a)(3) / §164.504(e)(2)(i): a business associate may use PHI only as its contract permits; product improvement for the vendor's own benefit is not within the §164.504(e)(2)(i)(A) management-and-administration carve-out and is not a default permitted use.",
  "reasoning": "The product's core function is AI processing of PHI, and 'develop and improve our Products and Services' is the loop an AI product runs on the data it processes. The policy reserves that use but never states whether the loop touches PHI. The no-mining and no-sale commitments do not reach it, because model improvement is neither. A covered entity reading the public documents cannot determine whether PHI, or signal derived from it, feeds model development.",
  "data_class_confidence": 0.9
}

Note the data class is insufficient information, not PHI. Stamping it "PHI" would overclaim and break the scope statement. The ambiguity is the finding, and it is the most defensible form of it.

Important Guidelines

• Quote verbatim, cite the source. Never paraphrase the document language a finding rests on.
• "Insufficient information" is a result. When the documents do not let a covered entity determine whether a use touches PHI, say exactly that. Do not resolve the ambiguity by guessing.
• Classify use from the fixed taxonomy. If a claim does not fit, note it, but do not invent a new use mid-run.
• Select the requirement by lookup, not by inference. If (use × data_class) maps to "none applies," the only remaining question is cross-document consistency.
• Keep every finding to the public record. The phrase to reach for is "a covered entity reading these public materials cannot determine ..." — never "the company does X with PHI."
• The ratification call is out of scope for this skill. Whether a finding is material enough to act on, and any remediation or outreach language, is human judgment held outside this artifact.

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Regulatory Reference

Verbatim text of the provisions this assessment checks against, from 45 CFR Part 164 (current as of Jan. 7, 2026). Check vendor language against this text directly; do not retrieve it elsewhere.

§ 164.502 — Uses and disclosures of protected health information: General rules

(a) Standard. A covered entity or business associate may not use or disclose protected health information, except as permitted or required by this subpart or by subpart C of part 160 of this subchapter.

(a)(1) Covered entities: Permitted uses and disclosures. A covered entity is permitted to use or disclose protected health information as follows: (i) To the individual; (ii) For treatment, payment, or health care operations, as permitted by and in compliance with § 164.506; (iii) Incident to a use or disclosure otherwise permitted or required by this subpart, provided that the covered entity has complied with the applicable requirements of §§ 164.502(b), 164.514(d), and 164.530(c) with respect to such otherwise permitted or required use or disclosure; (iv) Except for uses and disclosures prohibited under § 164.502(a)(5)(i), pursuant to and in compliance with a valid authorization under § 164.508; (v) Pursuant to an agreement under, or as otherwise permitted by, § 164.510; and (vi) As permitted by and in compliance with any of the following: (A) This section. (B) Section 164.512 and, where applicable, § 164.509. (C) Section 164.514(e), (f), or (g).

(a)(3) Business associates: Permitted uses and disclosures. A business associate may use or disclose protected health information only as permitted or required by its business associate contract or other arrangement pursuant to § 164.504(e) or as required by law. The business associate may not use or disclose protected health information in a manner that would violate the requirements of this subpart, if done by the covered entity, except for the purposes specified under § 164.504(e)(2)(i)(A) or (B) if such uses or disclosures are permitted by its contract or other arrangement.

(a)(5)(ii) Sale of protected health information. (A) Except pursuant to and in compliance with § 164.508(a)(4), a covered entity or business associate may not sell protected health information. (B) For purposes of this paragraph, sale of protected health information means: (1) Except as provided in paragraph (a)(5)(ii)(B)(2) of this section, a disclosure of protected health information by a covered entity or business associate, if applicable, where the covered entity or business associate directly or indirectly receives remuneration from or on behalf of the recipient of the protected health information in exchange for the protected health information. (2) Sale of protected health information does not include a disclosure of protected health information: (i) For public health purposes pursuant to § 164.512(b) or § 164.514(e); (ii) For research purposes pursuant to § 164.512(i) or § 164.514(e), where the only remuneration received by the covered entity or business associate is a reasonable cost-based fee to cover the cost to prepare and transmit the protected health information for such purposes; (iii) For treatment and payment purposes pursuant to § 164.506(a); (iv) For the sale, transfer, merger, or consolidation of all or part of the covered entity and for related due diligence as described in paragraph (6)(iv) of the definition of health care operations and pursuant to § 164.506(a); (v) To or by a business associate for activities that the business associate undertakes on behalf of a covered entity, or on behalf of a business associate in the case of a subcontractor, pursuant to §§ 164.502(e) and 164.504(e), and the only remuneration provided is by the covered entity to the business associate, or by the business associate to the subcontractor, if applicable, for the performance of such activities; (vi) To an individual, when requested under § 164.524 or § 164.528; (vii) Required by law as permitted under § 164.512(a); and (viii) For any other purpose permitted by and in accordance with the applicable requirements of this subpart, where the only remuneration received by the covered entity or business associate is a reasonable, cost-based fee to cover the cost to prepare and transmit the protected health information for such purpose or a fee otherwise expressly permitted by other law.

(b)(1) Minimum necessary applies. When using or disclosing protected health information or when requesting protected health information from another covered entity or business associate, a covered entity or business associate must make reasonable efforts to limit protected health information to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request.

(d) Uses and disclosures of de-identified protected health information. (1) Uses and disclosures to create de-identified information. A covered entity may use protected health information to create information that is not individually identifiable health information or disclose protected health information only to a business associate for such purpose, whether or not the de-identified information is to be used by the covered entity. (2) Uses and disclosures of de-identified information. Health information that meets the standard and implementation specifications for de-identification under § 164.514(a) and (b) is considered not to be individually identifiable health information, i.e., de-identified. The requirements of this subpart do not apply to information that has been de-identified in accordance with the applicable requirements of § 164.514, provided that: (i) Disclosure of a code or other means of record identification designed to enable coded or otherwise de-identified information to be re-identified constitutes disclosure of protected health information; and (ii) If de-identified information is re-identified, a covered entity may use or disclose such re-identified information only as permitted or required by this subpart.

(e)(1) Disclosures to business associates. (i) A covered entity may disclose protected health information to a business associate and may allow a business associate to create, receive, maintain, or transmit protected health information on its behalf, if the covered entity obtains satisfactory assurance that the business associate will appropriately safeguard the information. A covered entity is not required to obtain such satisfactory assurances from a business associate that is a subcontractor. (ii) A business associate may disclose protected health information to a business associate that is a subcontractor and may allow the subcontractor to create, receive, maintain, or transmit protected health information on its behalf, if the business associate obtains satisfactory assurances, in accordance with § 164.504(e)(1)(i), that the subcontractor will appropriately safeguard the information.

§ 164.504(e) — Business associate contracts

(e)(2) Implementation specifications: Business associate contracts. A contract between the covered entity and a business associate must: (i) Establish the permitted and required uses and disclosures of protected health information by the business associate. The contract may not authorize the business associate to use or further disclose the information in a manner that would violate the requirements of this subpart, if done by the covered entity, except that: (A) The contract may permit the business associate to use and disclose protected health information for the proper management and administration of the business associate, as provided in paragraph (e)(4) of this section; and (B) The contract may permit the business associate to provide data aggregation services relating to the health care operations of the covered entity. (ii) Provide that the business associate will: (A) Not use or further disclose the information other than as permitted or required by the contract or as required by law; (B) Use appropriate safeguards and comply, where applicable, with subpart C of this part with respect to electronic protected health information, to prevent use or disclosure of the information other than as provided for by its contract; (C) Report to the covered entity any use or disclosure of the information not provided for by its contract of which it becomes aware, including breaches of unsecured protected health information as required by § 164.410; (D) In accordance with § 164.502(e)(1)(ii), ensure that any subcontractors that create, receive, maintain, or transmit protected health information on behalf of the business associate agree to the same restrictions and conditions that apply to the business associate with respect to such information; (E) Make available protected health information in accordance with § 164.524; (F) Make available protected health information for amendment and incorporate any amendments to protected health information in accordance with § 164.526; (G) Make available the information required to provide an accounting of disclosures in accordance with § 164.528; (H) To the extent the business associate is to carry out a covered entity's obligation under this subpart, comply with the requirements of this subpart that apply to the covered entity in the performance of such obligation; (I) Make its internal practices, books, and records relating to the use and disclosure of protected health information received from, or created or received by the business associate on behalf of, the covered entity available to the Secretary for purposes of determining the covered entity's compliance with this subpart; and (J) At termination of the contract, if feasible, return or destroy all protected health information received from, or created or received by the business associate on behalf of, the covered entity that the business associate still maintains in any form and retain no copies of such information or, if such return or destruction is not feasible, extend the protections of the contract to the information and limit further uses and disclosures to those purposes that make the return or destruction of the information infeasible.

(e)(4) Other requirements for contracts and other arrangements. (i) The contract or other arrangement between the covered entity and the business associate may permit the business associate to use the protected health information received by the business associate in its capacity as a business associate to the covered entity, if necessary: (A) For the proper management and administration of the business associate; or (B) To carry out the legal responsibilities of the business associate. (ii) The contract or other arrangement between the covered entity and the business associate may permit the business associate to disclose the protected health information received by the business associate in its capacity as a business associate for the purposes described in paragraph (e)(4)(i) of this section, if: (A) The disclosure is required by law; or (B)(1) The business associate obtains reasonable assurances from the person to whom the information is disclosed that it will be held confidentially and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person; and (2) The person notifies the business associate of any instances of which it is aware in which the confidentiality of the information has been breached.

(e)(5) Business associate contracts with subcontractors. The requirements of § 164.504(e)(2) through (e)(4) apply to the contract or other arrangement required by § 164.502(e)(1)(ii) between a business associate and a business associate that is a subcontractor in the same manner as such requirements apply to contracts or other arrangements between a covered entity and business associate.

§ 164.508(a) — Uses and disclosures for which an authorization is required

(a)(3) Authorization required: Marketing. (i) Notwithstanding any provision of this subpart, other than the transition provisions in § 164.532, a covered entity must obtain an authorization for any use or disclosure of protected health information for marketing, except if the communication is in the form of: (A) A face-to-face communication made by a covered entity to an individual; or (B) A promotional gift of nominal value provided by the covered entity. (ii) If the marketing involves financial remuneration, as defined in paragraph (3) of the definition of marketing at § 164.501, to the covered entity from a third party, the authorization must state that such remuneration is involved.

(a)(4) Authorization required: Sale of protected health information. (i) Notwithstanding any provision of this subpart, other than the transition provisions in § 164.532, a covered entity must obtain an authorization for any disclosure of protected health information which is a sale of protected health information, as defined in § 164.501 of this subpart. (ii) Such authorization must state that the disclosure will result in remuneration to the covered entity.

§ 164.514 — De-identification and other requirements

(a) Standard: De-identification of protected health information. Health information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual is not individually identifiable health information.

(b) Implementation specifications: Requirements for de-identification of protected health information. A covered entity may determine that health information is not individually identifiable health information only if: (1) A person with appropriate knowledge of and experience with generally accepted statistical and scientific principles and methods for rendering information not individually identifiable: (i) Applying such principles and methods, determines that the risk is very small that the information could be used, alone or in combination with other reasonably available information, by an anticipated recipient to identify an individual who is a subject of the information; and (ii) Documents the methods and results of the analysis that justify such determination; or (2)(i) The following identifiers of the individual or of relatives, employers, or household members of the individual, are removed: (A) Names; (B) All geographic subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code if, according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000. (C) All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older; (D) Telephone numbers; (E) Fax numbers; (F) Electronic mail addresses; (G) Social security numbers; (H) Medical record numbers; (I) Health plan beneficiary numbers; (J) Account numbers; (K) Certificate/license numbers; (L) Vehicle identifiers and serial numbers, including license plate numbers; (M) Device identifiers and serial numbers; (N) Web Universal Resource Locators (URLs); (O) Internet Protocol (IP) address numbers; (P) Biometric identifiers, including finger and voice prints; (Q) Full face photographic images and any comparable images; and (R) Any other unique identifying number, characteristic, or code, except as permitted by paragraph (c) of this section; and (ii) The covered entity does not have actual knowledge that the information could be used alone or in combination with other information to identify an individual who is a subject of the information.

(c) Implementation specifications: Re-identification. A covered entity may assign a code or other means of record identification to allow information de-identified under this section to be re-identified by the covered entity, provided that: (1) Derivation. The code or other means of record identification is not derived from or related to information about the individual and is not otherwise capable of being translated so as to identify the individual; and (2) Security. The covered entity does not use or disclose the code or other means of record identification for any other purpose, and does not disclose the mechanism for re-identification.

(e) Limited data set. A covered entity may use or disclose a limited data set — protected health information that excludes the sixteen direct identifiers listed in § 164.514(e)(2) (names, postal address information other than town/city, State, and zip code, telephone numbers, fax numbers, email addresses, social security numbers, medical record numbers, health plan beneficiary numbers, account numbers, certificate/license numbers, vehicle identifiers, device identifiers, URLs, IP addresses, biometric identifiers, and full-face photographic images) — only for the purposes of research, public health, or health care operations, and only pursuant to a data use agreement meeting the requirements of § 164.514(e)(4). A limited data set is still protected health information; it is not de-identified.

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This skill is part of the Rote Compliance Skills, open-sourced by Dang's Solutions.

Want to run this at scale? Rote is a compliance platform that reads a healthcare-AI vendor's public materials, checks product claims against the company's own documents and against the regulations, and surfaces the gaps a covered entity would hit during vendor review.