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The New Era of Regulatory Enforcement: A Comprehensive Guide for Raising the Bar to Manage Risk by Timothy P. Hedley, Richard H. Girgenti

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Chapter 10

Fraud and Misconduct in Healthcare

Glen E. Moyers

The passage of the Patient Protection and Affordable Care Act (PPACA) in 2010 has had a significant impact on the healthcare industry, drawing attention to the way healthcare is delivered and patients are covered by healthcare services. At the same time, it has raised the level of regulatory scrutiny of the healthcare industry.

The healthcare industry is comprised of two segments, providers and payers, which have different operating models, operational challenges, and regulatory environments. Healthcare providers face a myriad of government regulations and increased enforcement activity. The vast majority of enforcement activity in the past decade has been aimed at providers who ...

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