How to realize the automation of auditing work has become the goal pursued by auditors, and the development and application of RPA technology brings opportunities and challenges for realizing audit automation. This paper proposes an ESG automated auditing technology by integrating ESG and K-means clustering algorithms on the basis of RPA automation technology. Then, through actual cases, we explore the effect of ESG automated auditing on auditing in practice. Using ESG automated auditing technology to practice the application of drug charging behavior in Hospital A. Using the K-mans algorithm to mine the potential relationship between drugs and conduct correlation analysis of drugs, the study finds that ESG automated auditing technology can effectively help auditors to complete their work, realize the automation and intelligence of intelligent auditing, save auditing manpower costs, and improve efficiency. To further analyze the impact of ESG automation auditing technology on audit quality, regression analysis was conducted on pharmaceutical companies in Hospital A. The regression results show that the regression coefficient of ESG automation auditing is -0.004, which is unchanged at a 1% statistical level, indicating that ESG automation auditing technology is significantly negatively correlated with manipulatable accrued profits, i.e., the better ESG automation auditing technology is, the higher its audit quality is.