Compliance Insights

The OIG's April 2026 FAQ update is explicit: Stark compliance and fair market value alone don't shield an arrangement from the Anti-Kickback Statute. Intent governs — and most programs aren't built to document it.

Spreadsheets capture data; audits demand evidence. Why Excel structurally fails the Stark/AKS documentation trail — five failure modes and the five-minute test that exposes them.

The compliance program obligations in OhioHealth's antitrust settlement mirror Corporate Integrity Agreement patterns familiar from Stark Law and AKS enforcement. The operational lessons cross statutes.

Most institutions refresh FMV opinions annually. Enforcement cases show that calendar cadence isn’t sufficient when material change events render existing opinions non-defensible. The three-cadence framework — calendar, trigger, and continuous monitoring — that compliance programs should adopt.

Professional Service Agreements between hospitals and physicians face scrutiny under the Anti-Kickback Statute's personal services safe harbor (42 CFR §1001.952(d)). Three enforcement failure modes — compensation drift, volume/value methodology drift, and service specification mismatch — reveal where PSA compliance documentation breaks down. Element-by-element framework + defensibility checklist for compliance officers managing PSA portfolios.

Across ArrowISE's 18-case enforcement library, ten federal settlements from 2020 through early 2026 account for $1.313 billion in combined recoveries (with Independent Health structured as up to $98M). The cases group cleanly into three operational categories: Stark FMV/Compensation ($565M, 6 cases), AKS Safe Harbor ($31.5M, 1 case), and Medicare Advantage Risk-Adjustment ($716.85M, 3 cases). Each category requires a distinct operational response.

Most compliance programs review physician arrangements annually. The enforcement environment now demands quarterly rigor. Six concrete questions your audit committee should be asking every quarter — covering FMV refresh cycles, commercial reasonableness, exclusion-list cadence, productivity- tier integrity, real-time monitoring, and documentation defensibility. Built for forwarding to peers.

OIG published the Medicare Advantage ICPG in February 2026 — the second ICPG in the OIG's modernization effort. For hospitals running MA contracts alongside physician arrangements, the document creates new audit expectations at the intersection of risk-adjustment integrity and physician-compensation structure. Six concrete questions for the next 90 days.

How CMS's 2.5% wRVU efficiency adjustment created a compliance gap most compliance programs haven't operationalized yet. Same clinical work now generates fewer wRVUs, which silently shifts FMV math across $/wRVU arrangements, productivity-bonus tiers, and quality-and- citizenship structures — and three questions every CCO should answer before Q3.

Why record FCA recoveries should change how you track physician arrangements this quarter. The DOJ's $6.8B FY2025 total wasn't a fluke — three structural shifts in enforcement intensity, agency coordination, and prosecutorial theory mean an unrefreshed FMV opinion is no longer a documentation deficiency. It's a predicate.