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Compliance risks associated with medical necessity happen when providers fail to show clinical evidence that a service is essential for a patient’s health. This often leads to legal, financial and operational consequences.
With the release of the CIA changes within the General Compliance Program Guidance (GCPG), the OIG has officially moved the goal posts. This isn’t just a new set of rules for organizations under investigation.
The May 2026 update to the Corporate Integrity Agreement (CIA) framework signals a definitive shift from passive reporting to active governance. Compliance is no longer an administrative sub-function. It’s now a board-level strategic imperative.
Healthcare compliance leadership requires choosing between the “hard” of stagnation and the “hard” of growth. This post by John R. Nocero and Andrea L. Bordonaro explores how to
When a new regulation or update is enacted, the clock starts ticking toward its inevitable effective date and another compliance deadline. Regulatory change management is a moving target with constant deadlines and uncertain task status.
This is the first article in a series on medical necessity — an area that many compliance programs struggle with. In this piece, we explain the medical necessity compliance risk in general, while subsequent articles highlight specific examples of enforcement actions experienced by medical providers such as hospitals and health systems.
For years healthcare leaders have been faced with demonstrating their value and answering the question, “How is compliance doing?” Getting the answers typically involves a scattered, manual process of pulling data from multiple sources, departments, and teams, then going through the process of aggregating that data to pull important, need-to-know information. By the time that step is complete, often the information is already out of date.
YouCompli is the leading healthcare compliance software designed to simplify regulatory change management. Our intuitive platform empowers compliance teams to interpret, operationalize, and track regulatory requirements with confidence. Trusted by healthcare organizations nationwide, YouCompli streamlines policy updates, workflows, and accountability—making regulatory compliance more manageable and effective. Discover why top hospitals and health systems choose YouCompli for reliable, efficient healthcare regulatory management software.