Five years ago, provider data accuracy rarely surfaced in board discussions. Today, it should.
Recent enforcement actions reveal a structural shift in how regulators and courts evaluate the impact of inaccurate provider information. Settlements are no longer limited to civil penalties. They increasingly impose mandated, multi-year compliance programs that require sustained capital investment, executive oversight, and formal reporting obligations.
The Health Net settlement is illustrative. While public attention focused on the $40 million penalty, the agreement also required approximately $28.5 million in additional compliance remediation—covering audits, process redesign, reporting infrastructure, and ongoing monitoring.
In practical terms, the cost of non-compliance was not $40 million.
It was materially higher.
This reframing matters for boards and executive leadership because it moves provider data accuracy out of the realm of operational hygiene and into capital allocation. Compliance investments now compete directly with growth initiatives, technology modernization, and strategic acquisitions. They consume multi-year budget capacity and management attention.
The economic logic has inverted. Historically, organizations justified underinvestment in provider data based on low enforcement probability and limited downside. That rationale no longer holds.
When the cost of proactive compliance is lower than the expected cost of enforcement, rational organizations invest early. When it is not, they defer, and absorb the consequences later through penalties, remediation mandates, and reputational exposure. Boards are now being asked to evaluate provider data accuracy alongside cybersecurity, financial controls, and regulatory reporting, areas where failure creates material enterprise risk rather than isolated operational disruption.
See how payer operations teams can help executive leadership shift provider data accuracy from a remediation expense to a controlled, auditable compliance investment with Polus™ HCP.