Preparing Health Care Compliance Programs for AI-Driven Enforcement
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What is the overall focus of the episode on AI‑driven health‑care enforcement?
This episode of AHLA Speaking of Health Law is sponsored by Pinnacle Healthcare Consulting. For more information, visit ask.com.
Welcome everybody. Thanks for joining this AHLA podcast. I'm Drew Hoffman. I'll be your host for today's conversation, uh, preparing compliance programs for AI driven enforcement. This discussion will combine AI and fraud and abuse enforcement, which are two topics that are likely very top of mind for all of us these days. Hopefully this will bring a new, a little bit of a fresh perspective and angle to these topics. I'm joined today by two terrific guests, Darren's Darren and Adam, who spend their time advising clients on exactly these issues. Over the course of the discussion, we'll explore, you know, several different things, how regulatory agencies are using AI in practice, what that means for healthcare organizations, and some concrete steps organizations can take now to get their compliance programs AI ready, so to speak.
So, you know, let's start things off with some quick intros and backgrounds. Uh Darren, why don't we start with you?
Absolutely. Thank you. Um, Drew. My name is Darren Scales. I'm a a partner at the law firm of Nelson Mullins. We are a nationwide law firm. With a very large healthcare group. We have about 70 plus of us. I'm on the transactional regulatory side of healthcare. So um I advise clients on setting up compliance programs, uh, which were obviously more traditional around HIPAA, fraud and abuse, etc. Bringing in the AI question uh today is very exciting because I see this process. Is really broken open in a lot of ways. So when I'm talking to you, I'm talking to you from the perspective of your regulatory and transactional attorney who advises clients in-house and helps them as they set up their programs and as they have issues along the way, trying to avoid uh some of the problems they they would have down the road when you need to hire Adam to step in and uh defend you.
I'll take the I'll take the handoff. That's great. Thank you. Uh Adam Taroski, I'm a partner at Nixon Peabody in Washington, DC. Um like Nelson Mullins, we're a nationwide practice. Um we have a large healthcare group, although I am technically part of our government investigations and white collar group. uh even though almost all of my clients are in the healthcare industry. Um I lead the firm's false claims act team. Uh I guess my claim to fame was my time at the Justice Department in the civil fraud section. Which is the section of the department that investigates and prosecutes False Claims Act cases nationwide. My current practice, of course, is a defense practice. I defend False Claims Act investigations.
Occasionally they make their way to litigation, in which case I litigate False Claims Act cases. But I also do what I call my day job. So in between subpoenas and civil investigative demands. I do compliance counseling and I work with institutional clients of the firm to develop compliance programs that hopefully. uh avoid uh government scrutiny or if there is government scrutiny what positions them well to to kind of respond to that.
Great. Well, thank you both. And um, like I said, I'm Drew Hoffman. I'm a partner with Pinnacle Healthcare Consulting. Um, I work on Pinnacle's compensation valuation team. So um I am not an attorney, but um work very closely with in-house outside counsel on compliance matters around um fair market value, commercial reasonableness, and all types of um provider compensation, transaction support. Um we do compensation. plan design, you know, policy and procedure development, all with a you know compliance, uh compliance focused, I think, um, you know, I think said well there to you know either prevent uh prevent compliance issues or get ahead and help tell the you know have a good documentation good story um ready for when when things might be questioned so um really excited for the um you know the discussion today
I think the three of us really bring um a well rounded perspective um to this issue. So Let's go ahead and dive in.
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Chapters
8 chapters
1
What is the overall focus of the episode on AI‑driven health‑care enforcement?
0:04–6:24
2
Who are the guests and what are their backgrounds in health‑care compliance and litigation?
6:24–12:39
3
How does AI change the traditional “pay‑and‑chase” enforcement model to a “detect‑and‑prevent” approach?
12:39–21:08
4
What recent government AI inventories and executive orders reveal about agency AI use?
21:08–27:28
5
What concrete steps should health‑care organizations take now to make their compliance programs AI‑ready?
27:28–33:09
6
How can health‑care entities evaluate and govern AI tools, vendors, and data‑privacy risks?
33:09–38:12
7
What are the practical challenges of using AI for medical‑coding and claim‑level decisions?
38:12–43:04
8
What key takeaways and actionable recommendations did the panel share for compliance leaders?
43:04–46:15
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