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
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 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
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
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
On February 25, 2025, President Trump signed an Executive Order directing federal agencies to “rapidly implement and enforce” federal healthcare price transparency regulations....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
“Almost every stage of modern healthcare relies on stable and secure computer and network technologies.”
The above is a direct quote from the Office of Civil Rights for Health & Human Services (“OCR”) in its proposed...more
1/31/2025
/ Cybersecurity ,
Data Breach ,
Data Privacy ,
Data Security ,
Electronic Protected Health Information (ePHI) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Health Technology ,
Healthcare ,
HIPAA Security Rule ,
OCR ,
Patient Privacy Rights ,
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 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
Last month the Office of Inspector General for the U.S. Department of Health & Human Services (OIG) released its first industry-specific compliance program guidance aimed at nursing facilities (both skilled and non-skilled)....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 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
Healthcare workers nationally are facing an increase in workplace violence, often instigated by patients and visitors. A study published earlier this year reported that almost 20% of healthcare workers have faced physical...more
10/17/2024
/ Employer Liability Issues ,
Essential Workers ,
Health and Safety ,
Health Care Providers ,
Healthcare ,
Healthcare Facilities ,
Healthcare Workers ,
Nurses ,
Patients ,
Physicians ,
Termination Rights ,
Workplace Safety ,
Workplace Violence
Most healthcare providers understand that routinely waiving patient cost-sharing obligations creates compliance issues under the Anti-Kickback Statute, the Civil Monetary Penalties Law, and third-party payor agreements which...more
One of the fundamental compliance requirements for healthcare providers is protecting the confidentiality and security of the patient health information you maintain. Most healthcare providers are subject to a federal law...more
Has a patient asked you or one of your providers if they could record a conversation or interaction with you? Would your staff know how to handle such a request? Requests from patients and their families to record...more
One of the biggest changes in healthcare over the past 15 years has been the move to electronic medical records. In 2009, only 12% of hospitals and 22% of physician practices utilized a certified electronic health record. As...more