Healthcare Fraud & Abuse Risk Analyzer
Assess healthcare compliance risks in minutes using AKS & Stark Law analysis
What You Can Do
Rapidly identify and evaluate compliance risks in healthcare business arrangements against the Anti-Kickback Statute (AKS), Stark Law, and False Claims Act regulations. Get detailed risk assessments that flag potential violations, highlight safe harbor protections, and prioritize mitigation strategies for your arrangements. Make informed compliance decisions backed by regulatory analysis and evidence-based best practices.
Features
Evaluates arrangements against all five elements of the Anti-Kickback Statute to identify prohibited inducements and referral relationships
Analyzes physician referral relationships and financial arrangements for both technical violations and practical enforcement risk
Identifies potential FCA exposure related to billing, documentation, and commercial reasonableness of healthcare arrangements
Identifies applicable regulatory safe harbors and specifies exact requirements needed to qualify for protection
Ranks identified risks by severity, enforcement likelihood, and recent DOJ/OIG settlement patterns
Provides specific, actionable corrective measures ranked by implementation priority and estimated effort
Generates compliance documentation requirements for retention, including fair market value appraisals and written agreements
Contextualizes risks against recent DOJ settlements, OIG alerts, and evolving enforcement priorities in healthcare
Example Output
Risk Assessment Summary
High Risk: Physician compensation formula does not meet Stark Law independent contractor standard. Recommend obtaining external FMV appraisal and restructuring to productivity-based model.
Medium Risk: Vendor arrangement lacks commercial reasonableness documentation under AKS. Safe harbor compliance requires fair-market-value support.
Mitigation Priority 1 (30 days): Commission written vendor agreement with FMV justification. Obtain Board approval. Document business purpose.
Enforcement Context: Similar arrangements resulted in $2.3M DOJ settlement in 2024. OIG focus areas: vendor selection process and referral volume correlation.
What's Included
- Risk Assessment Framework: Structured evaluation matrix covering AKS elements, Stark Law requirements, and FCA billing implications
- Safe Harbor Finder: Identifies applicable safe harbors and specifies exact compliance requirements to achieve regulatory protection
- Regulatory Reference Guide: Quick-access summaries of AKS, Stark Law, and FCA provisions with enforcement principles and recent interpretive guidance
- Mitigation Action Plan: Prioritized corrective measures with implementation timelines, responsible parties, and compliance verification steps
- Documentation Template: Compliance record checklist including agreements, appraisals, board minutes, and communications to retain for OIG review
- Enforcement Trend Summary: Analysis of recent DOJ settlements and OIG enforcement priorities contextualizing your arrangement-specific risks
Who It's For
- Compliance Officers
- Healthcare Attorneys
- Chief Financial Officers
- Business Development Managers
- Risk Management Directors
Best For
- Evaluating new physician compensation and referral arrangements
- Assessing vendor and third-party arrangements for compliance exposure
- Preparing for OIG audits and DOJ inquiries
- Reviewing existing arrangements during compliance program assessments
- Joint venture and partnership structure compliance analysis
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