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What Health Systems Need to Know about DME Billing Fraud: Three Areas to Watch

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Durable Medical Equipment (DME) billing remains a significant target of the government with regard to compliance risks. The insights and strategies in this blog offer guidance to help health systems avoid exposure and losses from DME fraud.

Where Does the Recent OIG Plan Focus? Highlights of Note

OIG’s latest report to Congress offers clues about where enforcement and oversight may be focused. Here are four areas healthcare compliance leaders should have on their radar.

Board of Directors OIG Revenue Cycle Risk Management

Four Things to Know About the FY 2027 IPPS Final Rule

The FY 2027 IPPS Final Rule is nearly 900 pages, but four areas deserve compliance leaders’ attention. Dr. CJ Wolf breaks down changes involving CJR-X, organ acquisition costs, quality reporting, and EHR interoperability, and explains why hospital compliance teams should start paying attention now.

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Don’t Let Pain Injections Cause Regulatory Compliance Pain

A recent OIG audit found that Medicare improperly paid an estimated $15.2 million for SI joint injections. CJ Wolf examines the coverage, billing, medical necessity, and documentation failures behind the findings and identifies three actions healthcare compliance teams can take to reduce risk.

Audit Billing OIG Revenue Cycle Risk Management

When Regulatory Compliance Controls Exist but Still Fail

A compliance control can be documented, automated and still fail to manage risk consistently. An HHS-OIG audit offers a practical example of why healthcare organizations need to look beyond whether controls exist and verify that they actually work.

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OIG Compliance North Star: Roadmap to the 2026 Modernized CIA Framework

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.

Board of Directors OIG Regulatory Change Management

OIG Cites Fraud, Waste and Abuse Concerns with Skin Substitutes

Many compliance professionals rely on HHS OIG focus areas as they perform risk assessments and plan subsequent auditing and monitoring activities. In November 2024, the OIG added an item to their Work Plan describing their intention to review Medicare Part B payments for skin substitutes.

This blog explores the implications for compliance and what health systems need to be aware of.

Billing OIG Revenue Cycle Risk Management

Know the Compliance Risk for Certain Anesthesia Services

A good healthcare compliance program is all about reducing risk, both in patient care and in financial reimbursement. This detailed blog by compliance expert, CJ Wolf, will bring you up to date on the compliance risks associated with certain anesthesia services.

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How to Avoid Compliance Risk in Peripheral Vascular Reimbursement

Peripheral vascular disease (PVD) reimbursement is fraught with potential compliance pitfalls. With increased scrutiny and worrisome statistics about improper payments, healthcare providers must identify and mitigate any PVD compliance risks that could jeopardize their operations.

This expert-written blog addresses the pressing concern of compliance risks in PVD reimbursement. It provides insights into regulatory trends, recent investigations and best practices.

Equip yourself with the knowledge to navigate this complex environment and safeguard your organization’s reputation and financial sustainability. Learn effective strategies to mitigate compliance risks in peripheral vascular reimbursement by focusing on medical necessity and adherence to guidelines.

Billing How To OIG Risk Management Tips

What Health Systems Need to Know about DME Billing Fraud: Three Areas to Watch

Where Does the Recent OIG Plan Focus? Highlights of Note

Four Things to Know About the FY 2027 IPPS Final Rule

Don’t Let Pain Injections Cause Regulatory Compliance Pain

When Regulatory Compliance Controls Exist but Still Fail

OIG Compliance North Star: Roadmap to the 2026 Modernized CIA Framework

OIG Cites Fraud, Waste and Abuse Concerns with Skin Substitutes

Know the Compliance Risk for Certain Anesthesia Services

How to Avoid Compliance Risk in Peripheral Vascular Reimbursement

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