Price Realism Requirement Must Be Stated to Allow Unacceptability Finding

As federal and state regulators alike continue to tout holding health care organizations accountable for alleged fraud, waste, and abuse as a top priority, ensuring compliance and minimizing enforcement risk has never been more imperative — or more challenging. Health care organizations operate at the intersection of rapid technological changes and within an increasingly complex regulatory landscape, where the rules governing scrutinized areas such as privacy, AI, billing integrity, and strategic transactions are being written, rewritten, and enforced in real time. Treating compliance as a periodic documentation exercise is simply not an option. Today, an effective risk mitigation strategy must be grounded in two complementary elements: a thorough understanding of evolving regulatory obligations and a candid internal assessment of potential points of exposure....