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Risk Management Centers for Medicare & Medicaid Services (CMS) Health Care Providers

Oberheiden P.C.

Pharmacy Claim Reversals: Mitigating Risk Before, During, and After an Investigation

Oberheiden P.C. on

Pharmacy claim reversals can be costly. Not only can they have an immediate impact on pharmacies’ cash flow; but, in many cases, they can lead to additional consequences as well. Pharmacies accused of improperly billing...more

Polsinelli

Virtual Oversight, Real Impacts: “Incident-To” and Beyond in CMS’s CY 2026 PFS Proposed Rule

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Key Takeaways - CMS proposes to significantly expand the use of virtual direct supervision for incident-to services, removing prior limitations based on Professional Component (PC)/Technical Component (TC) indicators and...more

Sheppard Mullin Richter & Hampton LLP

Potential False Claims Act Liability for Providers of Gender-Affirming Care for Minors

On July 9, 2025, the U.S. Department of Justice (“DOJ”) announced it sent more than 20 subpoenas to physicians and clinics involved in providing gender-affirming care to minors, and that the subpoenas related to...more

Polsinelli

CMS Proposes New Mandatory, Two-Sided Risk Model for Heart Failure and Low Back Pain

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Key Takeaways - CMS has proposed a mandatory two-sided risk model for specialists treating heart failure and low back pain in outpatient settings....more

Sheppard Mullin Richter & Hampton LLP

Takeaways from the America’s Physician Groups’ Spring Conference: Turbulent Times Call for Change and Innovation

“Kicking Off Accountable Care” served as the theme for this year’s America’s Physician Groups’ (“APG”) Spring Conference, a three-day event packed with compelling speakers and breakout sessions focused on the state of...more

Husch Blackwell LLP

False Claims Act Insights - How Payment Suspensions Can Impact FCA Litigation

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Host Jonathan Porter welcomes to the show Husch Blackwell partner Bryan Nowicki, a Madison-based member of the firm’s Healthcare group, to discuss payment suspensions involving the Centers for Medicare & Medicaid Services...more

Dentons

Ep. 60 – Assess EHR Safety Issues Using the 2025 SAFER Guides

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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

Dentons

Ep. 56 – Avoid these compliance mistakes when implementing delegated credentialing for telehealth providers

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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

Husch Blackwell LLP

Hospice Insights Podcast - Upping the Ante: Will CMS’s Enhanced Oversight Efforts Cause Hospices to Fold?

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CMS recently expanded its Provisional Period of Enhanced Oversight, or PPEO, in Arizona, California, Nevada, and Texas, and its enforcement activities nationwide appear more aggressive. In this episode, Husch Blackwell’s Meg...more

King & Spalding

CMS Issues Final 2025 Calendar Year Medicare Physician Fee Schedule Final Rule

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On November 1, 2024, CMS issued a rule finalizing changes to Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B policies effective on or after January 1, 2025 (the Final Rule). Section 1848 of...more

Foley & Lardner LLP

Risk Bearing Entity Requirements: An Introduction

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Providers and provider organizations are increasingly contracting with payors to manage specific patient pools and diseases on a risk basis. They are taking new and increasing financial risk to better align with payors’...more

Furia Rubel Communications, Inc.

Navigating the Regulatory Complexities of an Evolving Health Care System with Kathleen Fisher Enyeart, Counsel at Lathrop GPM

In this episode of On Record PR, Gina Rubel goes on record with Kathleen Fisher Enyeart, Counsel at Lathrop GPM, to discuss the challenges of complying with health care regulations in a complex and rapidly changing industry....more

Health Care Compliance Association (HCCA)

[Event] Regional Healthcare Compliance Conference - November 1st, Scottsdale, AZ

Looking for compliance education and networking in your area? HCCA’s Regional Healthcare Compliance Conferences offer practitioners convenient, local compliance education on a wide variety of current and emerging topics...more

Baker Donelson

Medical Records Scams: What You Need to Know

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In today's digital age, the health care industry faces a growing threat from scammers who don't have to use sophisticated cyberattacks; they can use the most routine task to steal information from unwitting and...more

Whiteford

New CMS EMTALA Portal Signals CMS Continued Focus on Enforcement Fight Against State Abortion Bans

Whiteford on

On May 21, the Centers for Medicare and Medicaid Services (CMS) announced a new option on CMS.gov to allow individuals to more easily file an Emergency Medical Treatment and Labor Act (EMTALA) complaint. Before launching the...more

Health Care Compliance Association (HCCA)

[Event] Regional Healthcare Compliance Conference - May 9th - 10th, San Juan, Puerto Rico

Looking for compliance education and networking in your area? HCCA’s Regional Healthcare Compliance Conferences offer practitioners convenient, local compliance education on a wide variety of current and emerging topics...more

Gardner Law

[Hybrid Event] “Steer” Clear of Legal Lassos: Readiness Strategies for FDA-Regulated Companies - May 1st, Austin, TX

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Join Gardner Law for a half-day CLE event in person at the Capital Factory in Austin, TX or attend virtually. Prepare for the regulatory rodeo with confidence by learning how to navigate regulatory, compliance, and privacy...more

Health Care Compliance Association (HCCA)

Privacy Briefs: March 2024

Research from Guidepoint Security found that 2023 saw an 80% increase in ransomware activity year-over-year, driven in part by multiple mass exploitation campaigns impacting hundreds of organizations. In total, the report...more

American Conference Institute (ACI)

[Event] 15th Annual Advanced Forum on Managed Care Disputes and Litigation - May 2nd - 3rd, Chicago, IL

ACI’s Advanced Forum on Managed Care Disputes and Litigation offers an unparalleled learning experience, specifically designed for the MCO legal community. Attend and develop winning legal strategies and business best...more

Health Care Compliance Association (HCCA)

‘An Unknown Individual Walked In’: Protecting Against Telehealth Risks Includes Non-IT Threats

The HHS Office for Civil Rights (OCR) and other government agencies aren’t just worried that providers understand—and mitigate—the privacy and security risks of telehealth. In fact, in 2022, the Government Accountability...more

Health Care Compliance Association (HCCA)

Transparency and the Open Payments Program

To quote CMS, “The Open Payments program is a national disclosure program that promotes a more transparent and accountable health care system. Open Payments houses a publicly accessible database of payments that reporting...more

Health Care Compliance Association (HCCA)

[Event] Regional Healthcare Compliance Conference - January 19th, Charlotte, NC

Looking for compliance education and networking in your area? HCCA’s Regional Healthcare Compliance Conferences offer practitioners convenient, local compliance education on a wide variety of current and emerging topics...more

Baker Donelson

How Health Care Providers Can Avoid Class Certification

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Introduction - Providing health care services comes with significant risk. When a provider is caring for the physical or emotional well-being of others, much can go wrong that potentially subjects the provider to a lawsuit....more

American Conference Institute (ACI)

[Event] 2nd Annual Legal, Regulatory and Compliance Summit on Medicare Advantage - November 2nd - 3rd, Nashville, TN

Hosted by American Conference Institute, the 2nd Annual Legal, Regulatory and Compliance Summit on Medicare Advantage returns for another exciting year with curated programming that will address the latest oversight and...more

Health Care Compliance Association (HCCA)

[Event] 2024 Managed Care Compliance Conference - January 29th - 30th, Coronado, CA

Explore the unique issues that are pertinent to managed care professionals! This annual event dedicated to compliance management for health plan providers is returning to an in-person format for 2024. Join your peers and...more

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