Over the past two years, federal and state government agencies have moved to regulate the deployment of artificial intelligence (AI) in the healthcare setting, including in the utilization management (UM) and prior...more
11/1/2024
/ Artificial Intelligence ,
Biden Administration ,
Congressional Intent ,
Department of Health and Human Services (HHS) ,
Executive Orders ,
Health Care Providers ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Hospitals ,
Med Tech ,
Medicare ,
Medicare Advantage ,
Medicare Advantage Organizations (MAOs) ,
New Legislation ,
Physicians ,
Prior Authorization ,
Regulatory Oversight ,
Regulatory Standards ,
Strategic Planning
The Criminal Division of the U.S. Department of Justice (DOJ) recently updated its Evaluation of Corporate Compliance Programs (ECCP) policy document, which prosecutors rely on to evaluate the effectiveness of compliance...more
10/31/2024
/ Analytics ,
Artificial Intelligence ,
Code of Conduct ,
Compliance ,
Department of Justice (DOJ) ,
Emerging Technologies ,
Enterprise Risks ,
Fraud ,
Health Care Providers ,
Risk Assessment ,
Risk Mitigation ,
Technology
The goal of value-based care (VBC) is to promote better care for individual patients and improved health outcomes for communities at reduced costs. This is an important and admirable purpose as many VBC stakeholders attempt...more
3/5/2024
/ ACOs ,
Alternative Payment Models (APM) ,
Anti-Kickback Statute ,
Artificial Intelligence ,
Centers for Medicare & Medicaid Services (CMS) ,
CMMI ,
Compliance ,
Department of Health and Human Services (HHS) ,
Federal Trade Commission (FTC) ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare Facilities ,
Industry Consolidation ,
Medicare ,
Medicare Advantage ,
OIG ,
Patient Privacy Rights ,
Regulatory Oversight ,
Rewards Programs ,
Value-Based Care
The Office of Inspector General of the U.S. Department of Health and Human Services (OIG) on Nov. 6, 2023, issued new General Compliance Program Guidance (GCPG) as a reference guide for the healthcare compliance community....more
The Centers for Medicare and Medicaid Services (CMS) has issued new guidance for frequently asked questions related to Medicare reimbursement for items and services provided in connection with the diagnosis and treatment of...more
The Centers for Medicare and Medicaid Services (CMS) continues to offer guidance related to the coronavirus (COVID-19) outbreak. On March 10, CMS issued a memo to all Medicare Advantage (MA) organizations and Part D sponsors...more
OIG Advisory Opinions -
Manufacturer's Free Replacement of Spoiled Pharmaceutical Products Authorized -
On Aug. 25, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG)...more
9/6/2017
/ Anti-Kickback Statute ,
Anti-Steering Rules ,
Appeals ,
Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
EMTs ,
Expert Testimony ,
False Claims Act (FCA) ,
False Statements ,
Food and Drug Administration (FDA) ,
FRCP 9(b) ,
Health Care Providers ,
Health Insurance ,
Hip Replacement ,
Hospitals ,
Litigation Strategies ,
Manufacturers ,
Medicaid Reimbursements ,
Medicare ,
Medicare Part D ,
Misrepresentation ,
OIG ,
Patient Safety ,
Pharmaceutical Industry ,
Prescription Drugs ,
Product Defects ,
Qui Tam ,
Retaliation ,
Reversal ,
Witness Preparation
After more than four years since the issuance of its Proposed Rule, the Centers for Medicare & Medicaid Services (CMS) will implement its Final Rule on the reporting and return of Medicare Parts A and B overpayments,...more