Compliance: These 3 Things Will Impact Fraud and Abuse

Why This Topic Matters

The topics discussed may influence how healthcare organizations manage enrollment disclosures, documentation practices, and referral arrangements. It is useful for compliance officers, billing leaders, legal teams, and provider organizations tracking federal enforcement and policy shifts.

Article Sections

1. Medicare Provider Enrollment Will Be Stricter Under New Rule

   This section summarizes CMS activity related to Medicare enrollment integrity and expanded review of provider and supplier affiliations. It focuses on a final rule and the general compliance implications for enrollment processes.

2. FCA Court Decision Consoles Worried Providers

   This section discusses a federal appellate court decision involving a hospice reimbursement dispute and the broader issue of claims liability. It addresses how the ruling may relate to documentation and medical necessity concerns.

3. Potential Stark Changes Aim to Match Quality Initiatives

   This section covers CMS and HHS/OIG discussion of the Physician Self-Referral Law and possible updates tied to quality initiatives and value-based care. It also references public comments, advisory opinions, and the Quality Payment Program.