The Financial Professional's Guide to Healthcare Reform

Chapter 10

Transparency and Program Integrity

The Patient Protection and Affordable Care Act (PPACA)¹ alone contains 59 separate sections of legislation dedicated to transparency and program integrity, 50 of which are found divided into the following subtitles in Title VI:

A. Physician ownership and other transparency.

B. Nursing home transparency and improvement.

C. Nationwide program for national and state background checks on direct patient access employees of long-term care facilities and providers.

D. Patient-centered outcomes research.

E. Medicare, Medicaid, and CHIP program integrity provisions.

F. Additional Medicaid program integrity provisions.

G. Additional program integrity provisions.

H. Elder Justice Act.

Title VI of PPACA enacts significant new transparency legislation and makes substantial modifications to existing administrative, civil, and criminal fraud and abuse statutes. As will be discussed further, PPACA amended the Stark Law² to restrict physician ownership of hospitals to those grandfathered as of December 31, 2010, and to provide limits on physician-owned hospitals' abilities to expand. PPACA also enacts new laws to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation, as well as protect and recognize elders' rights, including the right to be free of abuse, neglect, and exploitation.

The Affordable Care Act (ACA) provides for an infusion of $350 million in fraud and abuse enforcement funding, comprised of ...