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
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
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
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
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
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
Many healthcare organizations understand the importance of having a Compliance Committee but some struggle to use their committee effectively. The key to ensuring the Compliance Committee is effective is building smart...more
3/3/2025
/ Compliance ,
Compliance Monitoring ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
Health Care Providers ,
Healthcare ,
Healthcare Facilities ,
OIG ,
Policies and Procedures ,
Regulatory Requirements ,
Risk Assessment ,
Risk Management
As we routinely discuss on the podcast, much of the success of an organization’s compliance program depends on its culture. Creating and fostering a compliance-minded culture can help ensure employees report suspected...more
As we start a new year, January is a great time to plan ways to refresh your compliance programming for the upcoming year. Compliance training and activities can become stale. They often take a backseat to the day-to-day...more
As the ultimate decision-maker for your organization, your governing body needs to understand compliance and appreciate the compliance risks facing the organization as well as what is needed to mitigate those risks. This...more
Holiday gifts are a common marketing tool used by many businesses; however, in healthcare, they can create compliance issues. Most healthcare providers have a gift policy that limits the type of gifts and other business...more
In September, the United States Department of Justice (DOJ) updated its corporate compliance program guidance which outlines criteria to look for in determining whether an organization’s compliance program is “adequate and...more
In healthcare, compliance issues can quickly escalate into compliance nightmares, with serious implications for patient safety, legal liability, and an organization’s reputation. Among the most common compliance nightmares...more
It’s extremely hard to change an organization’s culture, but no one is in a better position to influence an organization’s culture than its Chief Executive Officer. Compliance starts at the top, and it’s important CEOs are...more
Looking for a simple, easy-to-implement way to lower your risk of overpayments? We have one on this week’s podcast!...more
The role of the compliance officer is often stressful. In 2022, the Corporate Compliance Institute published a survey of 240 compliance officers. According to the findings, 59% felt burned out, 51% have “a lot of” or “extreme...more
Lack of transportation can be a significant barrier to accessing healthcare services. According to a Robert Wood Johnson Foundation report, one in five patients report forgoing needed healthcare services due to lack of...more
Undoubtedly one of the most important responsibilities of the compliance officer is compliance training. Your best defense to a compliance problem is well-trained staff who not only know the organization’s policies but also...more