Mental Health, substance use disorder, and behavioral health compliance information for facilities and providers.
HHS-OIG is hunting a Brooklyn rehab owner over $18.4M in fraudulent Medicare and Medicaid claims. For behavioral health operators, the case is a working manual on what a real compliance program, chart audit cadence, and FWA controls need to look like right now.
The Department of Justice sentenced Done Global’s founder and clinical president in July 2026 for a $90 million Adderall distribution and health care fraud scheme. Behavioral health operators, particularly PE-backed platforms scaling telehealth, should read this as a direct signal on prescriber oversight and utilization review.
Joint Commission (JCAHO) accreditation is a deemed-status credential that CMS, state licensing agencies, and commercial payers rely on to gate reimbursement and network access. For behavioral health operators, it functions as a revenue and enterprise-value instrument, not a clinical trophy.
A behavioral health compliance officer walks through what it actually takes to launch an Intensive Outpatient Program: state licensure, ASAM Level 2.1 alignment, accreditation sequencing, EKRA exposure, and the capital math most consultants skip.
JCAHO is now The Joint Commission. For behavioral health operators, accreditation applies to your organization and certification applies to specific programs inside it. Here is what that distinction actually unlocks in payer access, deemed status, and enterprise value.
Starting an OTP means clearing four gatekeepers in the right order: the SOTA, SAMHSA CSAT, the DEA, and an accrediting body. Sariah Hopkins walks operators through the 12 to 24 month critical path, the 2024 rule changes, and the P&L realities.
Behavioral health operators keep asking for fun ways to prepare for Joint Commission surveys. The honest answer: gamified drills only work when they map directly to the BHC manual, NPSG.15.01.01, and the SAFER Matrix. Here is what we run, and what it changes on survey day.
CareSource’s retroactive Medicaid clawbacks in Ohio have pulled ODM, JMOC, and state lawmakers into the conversation. For behavioral health operators, this is a leading indicator of tightening post-payment audits. Here is what to do in the next 30, 60, and 90 days.
A behavioral health operator’s guide to the Optum credentialing application: Provider Express submission, CAQH ProView requirements, accreditation choice, NCQA cycles, and what to do when the application stalls at 90 days and your census is waiting.
Medicaid agencies in five states have throttled new behavioral health provider enrollment over FWA concerns. Credentialing timelines are stretching past 180 days, revalidation packets are getting kicked back, and site visits are pulling apart enrollment files. Here is how operators should respond.
