By NextBestFitPhase 5: Stabilize & govern · Step 5.2
Run program integrity & fraud control
Year 1 onward · UHA Program Integrity; HHS-OIG; DOJDiscuss this step
Pros & cons of this step
Pros
- +One national dataset makes patterns visible that fragmented payers miss.
Cons
- −Prepayment review slows payment to honest providers.
- Integrity vs. administrative burden on providers.
Trade-off behind each system change
- Stark law & Anti-Kickback StatuteUniform rules; more compliance obligations for providers who mainly served commercial patients.
- Medicare hospice benefitConcurrent care improves end-of-life choice but raises spending; stricter review burdens legitimate hospices.