Fraud and Abuse: Look for Big Compliance Changes, Thanks to Healthcare Reform

Why This Topic Matters

The article highlights federal enforcement and compliance changes that can affect provider cash flow, reporting obligations, and exposure to fraud-related liability. Understanding these topics helps healthcare organizations prepare for regulatory implementation and assess compliance risk.

Article Sections

1. Payment Suspension for Credible Allegations of Fraud

   Discusses the new healthcare reform framework for suspending payments during fraud investigations and the role of federal oversight agencies.

2. Other PPACA Compliance Provisions

   Summarizes additional compliance-related changes in the reform law affecting provider programs, repayment timing, and fraud enforcement.

3. Compliance Programs

   Covers the reform law’s requirement for Medicare provider compliance planning and related federal implementation discretion.

4. Repayment Timeliness

   Addresses the requirement to return identified overpayments within a specified time period and the compliance implications of missing that deadline.

5. False Claims Liability Increases

   Describes reform-related changes affecting fraud, kickback-related liability, and whistleblower actions under federal false claims law.