Compliance: 3 Recent Cases Show ED Fraud Vulnerabilities

Why This Topic Matters

Emergency departments and their supporting compliance teams can use this article to identify common risk areas that may attract payer scrutiny or government investigation. The discussion is relevant for organizations seeking to strengthen internal compliance processes and understand the general categories of conduct implicated in recent enforcement actions.

Article Sections

1. Medically Unnecessary Admissions from the ED

   Discusses an enforcement case involving emergency department admission practices and the compliance concerns raised by unnecessary inpatient utilization and related reporting issues.

2. Accepting Kickbacks for Unnecessary Prescriptions

   Covers a fraud case involving prescription-related allegations and uses it to discuss audit approaches, claim review timing, and internal monitoring considerations.

3. Committing Stark Violations

   Reviews a settlement involving referral relationship concerns and the broad compliance implications of federal physician self-referral rules.