The Health Care Program Compliance Guide is an all-in-one resource that will help ensure the integrity of your health care compliance program — developed especially for health care providers seeking reimbursement under Medicare, Medicaid, TRICARE, and other federal health care programs.

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Understand and stay abreast of nationwide government enforcement priorities, initiatives, actions, and changes in laws and regulations. Keep up with information regularly provided by the HHS Office of Inspector General, Justice Department, U.S. Attorneys.

Trusted Legal Analysis

Expert analysis from our editors, with substantial guidance and review from members of the American Bar Association Health Law Section.

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Topics Covered

  • Anti-kickback
  • Attribution of financial relationships
  • Billing for items or services not rendered
  • Billing for medically unnecessary services
  • Clinical research/drug  trials
  • Creation, retention, and destruction of records
  • Credit balances/failure to refund
  • Discounts and free items
  • Duplicate billing, unbundling and upcoding
  • Settlement agreements
  • Equipment and space rentals
  • False cost reports
  • Group practices
  • Hospice and nursing home relationships
  • Hospital admissions and discharges
  • Hospital incentives to physicians
  • Industry compliance guidelines
  • Joint ventures and acquisitions
  • Managed care
  • Marketing practices
  • Outpatient services
  • Oversight of contractors/subcontractors
  • Personal services and management agreements
  • Physician financial relationships
  • Privacy and security of medical records
  • Quality of care
  • Statutory and regulatory requirements
  • Teaching physicians/residents
  • Underutilization
  • Waiver or payment of copayments, deductibles, or premiums
Key Laws and Regulations
  • Anti-kickback statute
  • False Claims Act
  • Physician self-referral law (“Stark Law”)
  • Social Security Act, Title XVIII (Medicare)


Product Structure

Reference: analysis, guidance, and primary source material

Formats and Frequency

Print reference material is updated monthly.

Web reference available on the  Health Law Resource Center.

For information about the Health Care Program Compliance Guide, please contact our Customer Contact Center at 1.800.372.1033.