Compliance

In the past week, there has been a pronounced escalation in compliance scrutiny for Medicare and Medicaid, underscoring the need for health systems to prepare for rigorous audits and adherence to evolving regulations. The Office of Inspector General recently reported significant findings related to the scrutiny of Medicare Advantage diagnosis codes and chronic care management services, signaling potential risks for noncompliance and inflated billing practices. With heightened enforcement mechanisms anticipated under the Trump administration, as articulated by CMS, ACOs and value-based care stakeholders must proactively reassess their compliance strategies to avoid penalties and ensure the integrity of reimbursements, as emphasized in a recent analysis on compliance challenges and