Compliance: Keep the Feds Off Your Back with 3 Tips to Fight Fraud

Why This Topic Matters

Understanding common fraud-and-abuse trigger points helps practices strengthen documentation, support claims, and reduce exposure to audits, denials, penalties, and referral-law violations.

Article Sections

1. Medically Unnecessary

   Discusses documentation and claim-support concerns related to medical necessity and Medicare payment review. The section uses a federal enforcement example to illustrate the compliance risk area.

2. Upcoding

   Reviews billing accuracy issues involving higher-level evaluation and management reporting and the importance of documentation consistency. It also mentions how electronic systems can affect charge capture and review.

3. Kickback and Stark Violations

   Covers referral and financial-relationship compliance issues tied to physician self-referral and anti-kickback enforcement. The section focuses on Medicare-related arrangements and federal settlement activity.

4. Take Note of the OIG's Central Theme

   Summarizes the article's broader enforcement theme involving controlled substances and opioid-related investigations. It also points to federal resources and agency guidance for providers.