One of the biggest challenges for any busy compliance professional is staying abreast of all the changes in healthcare regulations, enforcement trends and risks. Yet doing so is critically important so that you have enough...more
We’ve reached the final episode in our Back-to-Basics: HIPAA Edition series! Over the past few weeks, we’ve explored some of the fundamental patient rights under HIPAA, including:
The right to access their PHI...more
Our Back-to-Basics series celebrates back-to-school season by taking a fresh look at some basic compliance obligations....more
It is back-to-school season, and The Healthcare Compliance Pod is going back to school too! Each week in August, we’re discussing one fundamental basic compliance obligation for healthcare providers, centered exclusively on...more
In celebration of the back-to-school season, the Healthcare Compliance Podcast is launching a new Back to Basics series—this time with a focus on patient rights under HIPAA. Each Thursday in August, the podcast will cover a...more
An encore presentation from Episode 33 In a recent episode of our podcast, we stepped away from our usual audience of compliance professionals to deliver an important message directly to CEOs and executive leadership. If...more
Make sure you’re providing good faith estimates to uninsured & self-pay patients -
Under the No Surprises Act, healthcare providers are required to offer Good Faith Estimates (GFEs) to self-pay and uninsured patients...more
As healthcare providers face mounting administrative burdens and tighter reimbursement rates, some are exploring the idea of charging patients for “extra” services, such as administrative tasks or added “perks.” But before...more
In the latest episode of The Healthcare Compliance Pod, we unpack how to provide meaningful access to language assistance – a topic that’s not only legally relevant due to Section 1557 changes but vital to patient safety and...more
If you’re preparing to launch an audit within your healthcare organization, pause for a moment and consider this: how well you plan before the audit begins can significantly affect the outcome—and your risk exposure. This...more
If you’re trying to strengthen your organization’s compliance program, one of the most important recommendations from the Office of Inspector General’s (OIG) General Compliance Program Guidance is to integrate quality and...more
As we hit the halfway point of 2025, now is the perfect time to revisit your compliance work plan. While it’s always good practice to assess whether your organization is meeting its compliance goals, this year presents a...more
6/20/2025
/ Compliance ,
Department of Justice (DOJ) ,
Diversity and Inclusion Standards (D&I) ,
Enforcement Priorities ,
False Claims Act (FCA) ,
Federal Funding ,
Gender Identity ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Risk Management
Physician compensation benchmarks like those from the Medical Group Management Association (MGMA) or the American Medical Group Associations) AMGA are commonly used in the healthcare industry. Organizations lean on them for...more
In today’s complex healthcare landscape, whistleblower claims are a major source of regulatory and legal risk for organizations. Last year saw a record number of “qui tam” claims filed under the False Claims Act. While...more
In April, a pharmaceutical manufacturer agreed to pay a $202 million settlement to resolve allegations of Anti-Kickback Statute (AKS) violations. At the heart of the case were speaker programs, where physicians and...more
The compliance officer is one of the most important positions within a healthcare organization, but also one of the most challenging. You’re expected to be a teacher, a coach, a project manager, a good listener, and a role...more
5/22/2025
/ Audits ,
Chief Compliance Officers ,
Compliance ,
Corporate Governance ,
Employees ,
Ethics ,
Health Care Providers ,
Healthcare ,
Healthcare Workers ,
Policies and Procedures ,
Risk Management ,
Training
In a recent False Claims Act case, a long-term care pharmacy and consulting services provider was found liable for submitting false claims to the government, resulting in a jury verdict of over $135 million in damages. The...more
If your organization uses Electronic Health Records (EHRs), the recent updates to the SAFER Guidelines (Safety Assurance Factors for EHR Resilience) are essential for helping you assess the potential safety issues posed by...more
5/8/2025
/ Artificial Intelligence ,
Centers for Medicare & Medicaid Services (CMS) ,
Cybersecurity ,
EHR ,
Electronic Medical Records ,
Electronic Protected Health Information (ePHI) ,
Health Care Providers ,
Healthcare ,
Healthcare Facilities ,
Risk Assessment ,
Risk Management
Cash-based practices, or providers who neither participate with nor bill insurers, are becoming increasingly common, especially in certain specialties such as primary care, women’s health, and mental health. While providers...more
5/1/2025
/ Beneficiaries ,
Compliance ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Insurance Claims ,
Medicare ,
Mental Health ,
Physicians ,
Regulatory Requirements ,
Reimbursements
Effective May 1, 2025, the Section 1557 regulations require covered healthcare providers to take reasonable steps by May 1, 2025, to identify and mitigate the risk of discrimination when they use AI and other emergency...more
4/24/2025
/ Algorithms ,
Artificial Intelligence ,
Bias ,
Compliance ,
Discrimination ,
Health Care Providers ,
Health Technology ,
Healthcare ,
Regulatory Requirements ,
Risk Management ,
Section 1557
Drug diversion can pose serious risks to patients, employees, and organizations. Any provider who stores, transports, or dispenses controlled substances should have a robust program designed to deter drug diversion and to...more
Delegated credentialing for telehealth providers has become commonplace since the Centers for Medicare & Medicaid Services (CMS) relaxed the Medicare Conditions of Participation for hospitals more than 10 years ago. Delegated...more
Compliance training is one of the most important responsibilities of the compliance officer. A provider’s best defense to non-compliance is well-trained employees who understand and follow your policies....more
Healthcare providers often have a detailed policy outlining when a minor may consent to care and when a parent or legal guardian’s consent is needed. Situations can arise in the treatment of minors that can make administering...more
Healthcare providers often have a detailed policy outlining when a minor may consent to care and when a parent or legal guardian’s consent is needed. Situations can arise in the treatment of minors that can make administering...more