Compliance & Oversight
Expert articles and analysis related to compliance & oversight.
AI Summary — Last 30 Days
In the past 30 days, the Trump administration's focus on compliance and oversight has intensified, as evidenced by CMS halting enrollment in Elevance's Medicare Advantage plans due to "substantial and persistent noncompliance" with customer information submission requirements. Additionally, a federal audit by HHS’s OIG revealed $285.2 million in improper payments for autism therapy in Colorado, emphasizing the ongoing scrutiny of Medicaid expenditures. These actions reflect a strategic shift towards stricter enforcement of regulations and financial stewardship, which will have significant implications for ACO leaders and payers aiming to navigate compliance in this evolving landscape. For more information, see CMS halts enrollment in Elevance’s Medicare Advantage plans and HHS's OIG audit findings.
Related Articles
6 Texas physicians to pay $5M to settle false claims allegations
Six South Texas physicians and their practices agreed to pay $4.9 million to resolve allegations they submitted false claims to Medicare, Medicaid and TriCare for services that were not rendered or no...
The Conduent Breach: A Stewardship Failure at Scale
EDITOR’S NOTE: The author of this article used AI-assisted tools in its composition, but all content, analysis, and conclusions were based on the author’s professional judgment and expertise. The arti...
STAT+: Federal Medicaid audit finds massive overpayment for autism therapy in Colorado
HHS's OIG uncovered $285.2 million in improper and potentially improper payments to clinicians of an autism therapy called applied behavior analysis, it said.
General Question for the Week of March 2, 2026
When it comes to oversight, what is the AMA's stance on artificial intelligence (AI)?
The hidden toll of physician regulatory investigations
I have spent my career believing in systems. As physicians, we are trained to trust oversight. We are taught that regulatory bodies exist to protect patients, maintain standards, and intervene when ca...
CMS announces pause on new durable medical equipment suppliers
The Trump administration issued a nationwide moratorium on new suppliers for certain medical equipment, citing fraud.
How AI Can Both Detect and Enable Fraudulent Research – The Monitor
A new study finds that nearly 10% of cancer research papers showed signs of being fabricated by “paper mills”. The problem may intensify as generative AI becomes more sophisticated, prompting lawmaker...
USPI surgical hospital to pay $5.6M to resolve alleged Stark law violations
Phoenix-based Southwest Orthopedic and Spine Hospital, doing business as Oasis Hospital, United Surgical Partners International and Dignity Phoenix Surgery Centers, agreed to pay $5.6 million to resol...
The Stark law dilemma facing physicians
Stark law was built to guard against financial conflicts in a fee-for-service world, but as healthcare shifts toward value-based care, many physicians say the decades-old framework is creating new fri...
DOJ sues OhioHealth for alleged anticompetitive contracts
The Department of Justice is suing OhioHealth for alleged anticompetitive contract restrictions.The DOJ's Antitrust Division and the Attorney General of Ohio filed the civil antitrust lawsuit on Feb. ...