In the second part of a Hospice News series on how regulators are using artificial intelligence (AI) tools to identify hospice fraud, Edo Banach, partner and co-chair of Foley Hoag’s Healthcare Department, spoke about the need for greater human oversight when AI is being utilized to spot potential fraud and the impact that the pivot to AI may be having on smaller hospices.

Banach said that some legitimate smaller organizations, which may not have the resources to adapt to AI-driven regulatory oversight or defend themselves against government revocations, are put at a disadvantage. “I feel like the government is trying to bury some of these providers in paperwork and make it almost impossible for them to continue operating,” he said. “They are not presumed to be innocent. They are presumed to be guilty through these revocations.”

Banach noted that although “this recent effort has been uniquely focused on small incentives and targeted at providers that CMS deems to be unsophisticated and less able to defend themselves,” some larger, more sophisticated providers are also facing difficult decisions. Banach emphasized the importance of investing in strong compliance functions to weather the government’s pivot to AI-enabled compliance.

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