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.
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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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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.
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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.
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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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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.
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The revenue cycle is the process that starts with a patient’s initial appointment and ends with full payment for services. It encompasses all the administrative and clinical functions that contribute to collecting patient service revenue. For healthcare organizations that provide services to patients, the revenue cycle is the organization’s financial lifeblood.
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Without a good employee education program, your quality program can suffer. And without a good quality program, patient care can suffer. Compliance can partner with quality to mitigate legal and reputational risks through good education practices.
This expert-written blog explains how to improve quality education programs and prepare employees to meet quality and compliance goals. To make the lesson stick, quality education is metaphorically compared to nail polish – an unlikely pairing but one that drives home the message brilliantly and memorably.
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In Q3, the exclusion screening software glitched. It missed a monthly sync. Then a second. By the third missed month, the compliance officer dismissed it as “a minor lag,” promising the HR department everything would be rerun soon.
Unfortunately, even a seemingly small glitch can have major consequences for healthcare compliance.”
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