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Managed Care Advisory Services
Managed Care Industry Experience Strategic Management has been providing compliance-related services to health insurance plans and managed care organizations (MCOs)…
Tuomey Healthcare Systems Found Guilty of Stark Violations
It is a violation of the Stark Law if a hospital contracts with outside physicians to provide surgery exclusively in…
Meeting the Challenge of Corporate Integrity Agreements and Independent Review Organizations
Introduction The Department of Justice (DOJ) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG),…
Is Healthcare Compliance Outsourcing an Option for Your Compliance Program?
Under the Affordable Care Act, CMS has been charged with developing mandated Healthcare Compliance Program (CP) standards that will be…
Anti-Kickback Statute Penalties and Violations: Medical Director and Advisory Agreements
It is important as part of ongoing auditing and monitoring to understand the importance of and how to review agreements…
IRO FAQs
Frequently Asked Questions OIG Corporate Integrity Agreements and Independent Review Organizations Listed below are several frequently asked questions about the…
Accountable Care Organizations Requirements: ACO Final Rule Summary
The Centers for Medicare & Medicaid Services (CMS) released the final rule for Accountable Care Organizations (ACOs) and the Medicare…
Auditing to Assess Email Compliance and Overall Program Effectiveness
Introduction Email is the most common form of communication used by organizations today. This means that any views, quotes, or…
HHS Issues Report on Stark Law Violations and Self-Referral Disclosure Protocol.
In a mandatory report to Congress, the Department of Health and Human Services (HHS) discussed the implementation of the Stark…
Statistics in Healthcare – Friend or Foe? – Taking the Compliance Office’s Perspective
Growing Importance of Statistics in Compliance Enforcement Data analytics, data mining, overpayment extrapolation using statistical concepts including sampling, and the overall…
Medicare Part D Compliance: A Day of Reckoning Approaches
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) [1] established the Medicare Part D outpatient prescription drug benefit, which…
Risk Assessment and Management
Health Care Regulatory Risk Management Regulatory compliance risk management is critical to the success of compliance operations. A robust risk…