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
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
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
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
Providers are required by federal law to return Medicare and Medicaid overpayments within 60 days of identifying the overpayment or they can be liable under the False Claims Act. Since 2016, providers have relied on Centers...more
Providers will often pay physicians for serving in important administrative roles within the organization. Compensation for administrative services can create risk to the organization under multiple laws, including the...more
We are halfway through 2024, which means: now is the perfect time to evaluate your 2024 compliance initiatives and assess how you’re doing! It’s time to give your compliance work plan a 6-month check-up....more
Is your organization’s culture complimenting your healthcare compliance program? Does it enhance and maximize your program’s effectiveness? Or, is your culture secretly sabotaging your compliance efforts?...more