Hospice News Series Examines AI Fraud Tools' Impact on Providers
In the second part of a two-part series, Hospice News reports that federal and state regulators are increasingly using AI and machine-learning tools, including CMS's Fraud Prevention System, to detect fraudulent billing and ownership patterns in hospice care. Legal experts quoted in the piece, including attorneys from Sheppard Mullin, Morgan Lewis, and Foley Hoag, warn that legitimate providers are getting swept up in enforcement actions, sometimes facing license revocation and 10-year re-enrollment bans based on algorithmic flags of ownership or staffing affiliations rather than clear evidence of fraud. Smaller hospices may lack resources to build compliance infrastructure to match regulators' data capabilities. The series highlights state hotspots including Arizona, California, Nevada, Texas, Georgia, and Ohio where fraudulent new-provider growth first drew scrutiny.