Governance - Health Care Compliance Brief

Government watchdog warns of Medicaid oversight gaps

Healthcare Dive

MARCH 18, 2024

The CMS doesn’t require states to report data on outcomes or care denials, and has made “delayed” progress on plans to analyze the information and make it public, according to the Government Accountability Office.

Governance

Governance Medicaid Medicaid

Federal government notches rare win in surprise billing lawsuit

Healthcare Dive

NOVEMBER 5, 2024

Last week, the 5th Circuit Court of Appeals sided with the federal government’s original interpretation of the No Surprises Act in determining how a key metric in billing disputes is calculated.

Governance

Government watchdog warns of Medicare fraud after relaxing provider requirements

Healthcare Dive

DECEMBER 20, 2022

The Government Accountability Office is urging the CMS to resume certain eligibility checks on providers whom they consider at high risk of fraud to the Medicare program.

Fraud

Fraud Governance Medicare Medicare

Microsoft forms health AI governance network

Healthcare Dive

MARCH 12, 2024

The tech giant is standing up the group with 16 health systems, two healthcare technology companies and zero AI development rivals.

Governance

HIPAA Compliance: Can Your Organization Avoid Costly Government Penalties and Fines?

Colington Consulting was established in 2013 and helps organizations achieve HIPAA compliance and ensures clients stay current with the latest enforcement trends. We provide a full range of HIPAA compliance services and consulting.

HIPAA

Federal government probes healthcare private equity deals

Healthcare Dive

MARCH 6, 2024

The cross-agency investigation comes as scrutiny rises regarding corporate consolidation in healthcare.

Governance

Navigating government affairs in healthcare: Driving quality improvements

Healthcare Dive

SEPTEMBER 9, 2024

In healthcare, serving people is the real Job 1. But we can only do that job effectively through a relentless focus on quality.

Governance

Insurer lobby blames government policies for 2025 Medicare Advantage market makeup

Healthcare Dive

OCTOBER 23, 2024

The Better Medicare Alliance is warning of disruptions to care for America’s seniors, though MA premiums and major benefits are essentially unchanged next year.

Medicare

Medicare Medicare Governance

‘As fast as possible but no faster than is safe’: Hospitals, tech companies confront AI governance

Healthcare Dive

MARCH 18, 2024

Regulators seeking to erect guardrails around AI are facing a Sisyphean task, experts said at HIMSS. How do you oversee something that is constantly changing?

Governance

Governance Hospitals

HIPAA: Why It Matters to Your Practice

Advertiser: Abyde

The large majority of practices are likely trying to protect patients’ information, but they may not be doing all that they need to meet government requirements. The government can fine up to 1.5 Not complying with HIPAA has definite drawbacks, with one major one being massive fines.

HIPAA

J&J sues federal government for halting 340B rebate plan

Healthcare Dive

NOVEMBER 13, 2024

The New Jersey-based drugmaker is trying to get the courts’ backing to pay hospitals rebates for two drugs in the 340B drug discount program, instead of offering upfront discounts.

Governance

Governance Hospitals

Major government ACOs to cover 13.2M people this year

Healthcare Dive

JANUARY 18, 2023

Accountable care organizations and value-based care advocates cheered the news, with the National Association of ACOs calling 2023 a “turning point” for growth.

Governance

J&J drops 340B rebate plan following government pressure

Healthcare Dive

OCTOBER 1, 2024

Threatened with steep sanctions and loss of its agreement with Medicare and Medicaid, Johnson & Johnson is rolling back a plan to give hospitals after-the-fact rebates for drugs in the 340B drug discount program.

Governance

Governance Medicaid Medicaid Medicare

California’s data exchange framework proves government can do big things

Healthcare Dive

SEPTEMBER 12, 2024

The secretary of California HHS argues that the state’s new data exchange improves health equity and streamlines information.

Governance

Eight Opportunities to Use the Law to Address Social Determinants of Health

Bill of Health

FEBRUARY 6, 2024

State Government Opportunities: States can increase expungement rates by amending laws to apply automatic expungement to minor drug possession convictions and seal the records. States can also remove barriers to local governments setting a livable local minimum wage. Code § 32) by making the tax credit monthly. 34:11-56a et seq.

Governance

Governance Public Health Local Policy Medicaid

Managing Competing Government Data Requirements and Best Practices to Balance Sharing with Protection

MRO Compliance

NOVEMBER 22, 2024

Plus, there’s a complex maze of national and state laws which govern when and how healthcare data can and should be shared. Startups that want appropriate access to data and some who want to push the envelope of what data should be shared. Patients who want access to their health data. And everything in between.

Governance

By outfitting police with telehealth iPads, mental health program saves government $62M

Healthcare IT News - Telehealth

MAY 24, 2024

reduction in inpatient hospitalizations for mental health crises from 2015 – 2021, resulting in cost savings of more than $62 million to federal and state governments. RESULTS Since beginning the iPad program, there has been a 93.1%

Governance

Governance Hospitals Licensing

NIST 2.0: Changes that Impact Cyber Programs and How Health Systems Can Adapt to the New ‘Govern’ Function

Healthcare IT Today

NOVEMBER 20, 2024

has significant enhancements , including the addition of the ‘govern’ function. The New ‘Govern’ Function NIST 2.0 The New ‘Govern’ Function NIST 2.0 The new ‘govern’ function informs how organizations achieve the other five original functions in the framework: identify, protect, detect, respond, and recover.

Governance

Governance Regulatory Compliance Compliance Hospitals

Government expects to recover more than $3B from healthcare fraud, misspent funds in fiscal year 2023

Healthcare Dive

DECEMBER 4, 2023

The HHS’ Office of the Inspector General’s report tallied 707 criminal enforcement actions and 746 civil actions for fraud and misspent funds in programs like Medicare and Medicaid.

Fraud

Fraud Governance Medicaid Medicaid

Seven Opportunities to Use the Law to Address Drug Policing

Bill of Health

JANUARY 2, 2024

By Jon Larsen and Sterling Johnson There is a well-established whole of government response to drug policing centered around the “war on drugs.” Policy changes must be considered to replace acknowledged failures and reimagine the whole of government response to drug policing.

US Department of Health and Human Services

US Department of Health and Human Services Governance Public Health Health Care Reform

The public health emergency is over. Here’s why the government must prioritize funding for long COVID research.

Healthcare Dive

JUNE 9, 2023

Professors at the University of Arizona argue for more robust infrastructure to understand and research long COVID-19, which impacts one in five Americans.

COVID-19

COVID-19 Public Health Governance

HHS facing challenges as lead agency for healthcare cybersecurity: GAO

Healthcare Dive

NOVEMBER 19, 2024

The department hasn’t implemented some policies recommended by the watchdog, which could pose a risk to cybersecurity in the sector as attacks increase, according to the Government Accountability Office.

Governance

Private equity investing in healthcare continues to slow

Healthcare Dive

MAY 8, 2024

Heightened antitrust scrutiny from state governments and regulators in Washington is having a chilling effect on deals, according to PitchBook analysts.

Governance

Climate Change and Sexual and Reproductive Health and Rights in Africa: The Urgent Need for Intersectional Approaches in Climate Change Policy and Governance

Bill of Health

DECEMBER 2, 2024

The post Climate Change and Sexual and Reproductive Health and Rights in Africa: The Urgent Need for Intersectional Approaches in Climate Change Policy and Governance first appeared on Bill of Health. Eunice is the current Executive Director of Akina Mama wa Afrika (AMwA).

Governance

Governance Public Health

How healthcare organizations should prepare for generative AI

Healthcare Dive

MARCH 7, 2024

Michael McCallen, managing director in Deloitte’s Health Care Strategy practice, explains why a governance structure is key to successful adoption of artificial intelligence.

Governance

California, Oregon eye universal health coverage

Healthcare Dive

APRIL 24, 2024

The states' proposals, which resemble Medicare for All, need approval from the federal government and face pushback from major health systems and insurers.

Medicare

Medicare Medicare Governance

Judge questions surprise billing ban implementation during court hearing

Healthcare Dive

DECEMBER 21, 2022

A federal judge tested the government’s defense concerning a rule designed to help third parties resolve payment disputes between healthcare providers and insurers.

Governance

National health spending reached $4.8T last year, CMS actuaries estimate

Healthcare Dive

JUNE 12, 2024

More Americans had insurance in 2023 than at any other time in the nation’s history, spurring medical utilization and accelerating healthcare spending faster than growth in the overall economy, according to government projections.

Governance

Uninsured rate expected to hit 8.9% over next decade, CBO finds

Healthcare Dive

JUNE 18, 2024

New government projections chart the dogged rise in the nation’s uninsured rate as policies that swelled healthcare coverage during the coronavirus pandemic expire.

Governance

Omnibus bill restarts Medicaid checks, lowers Medicare physician pay cuts

Healthcare Dive

DECEMBER 20, 2022

trillion omnibus spending package as they near a Friday deadline for government funding. Lawmakers are rushing to speed passage of the $1.7

Medicaid

Medicaid Medicaid Medicare Medicare

CMS rolls out provider flexibilities amid fallout from Change cyberattack

Healthcare Dive

MARCH 5, 2024

Provider groups said the government should go further to financially bolster providers during the outage at Change Healthcare.

Governance

Walgreens settles allegations of fraudulent billing with DOJ

Healthcare Dive

SEPTEMBER 16, 2024

The Illinois-based pharmacy giant has agreed to pay almost $107 million to settle claims it billed Medicare, Medicaid and other government programs for prescriptions that were never dispensed.

Medicaid

Medicaid Medicaid Medicare Medicare

National health spending reached $4.3 trillion in 2021

Healthcare Dive

DECEMBER 14, 2022

Increases in healthcare utilization and insurance coverage were offset by lower government spending on COVID-19, according to new CMS data.

COVID-19

COVID-19 Governance

Book Review: ‘The Truth Pill: The Myth of Drug Regulation in India’

Bill of Health

NOVEMBER 18, 2022

In fact, before publishing the book, the authors petitioned the government, highlighting glaring regulatory issues, but the government turned a blind eye. The book relies on primary sources of information — mainly government reports, judicial decisions, and government data.

Governance

Governance Bioethics FDA Public Health

ONC head Micky Tripathi on info-blocking complaints, provider penalties and future of TEFCA

Healthcare Dive

MARCH 25, 2022

Tripathi shared his thoughts on the scope and content of information-blocking complaints, when the industry can expect penalties for providers found information blocking and how the government plans to build on TEFCA moving forward.

Governance

Microsoft’s health VP takes on responsible AI

Healthcare Dive

MARCH 18, 2024

David Rhew talks about Microsoft's new AI governance network and the tech giant’s take on federal regulators’ plan to more actively oversee health AI.

Governance

State Medicaid spending fell below pre-pandemic levels during continuous enrollment

Healthcare Dive

JUNE 21, 2023

But spending will likely increase as the federal government begins to pare back its increased contribution. An analysis by KFF found state spending on Medicaid fell during the COVID-19 pandemic even as enrollment soared.

Medicaid

Medicaid Medicaid COVID-19 Governance

MACPAC wants Congress to force states to disclose Medicaid financing streams

Healthcare Dive

JUNE 12, 2024

The influential advisory group has been lobbying the federal government to collect more detailed information on how states loop providers into funding Medicaid for almost a decade.

Medicaid

Medicaid Medicaid Governance

CMMI teases new behavioral, maternal health models launching this year

Healthcare Dive

SEPTEMBER 15, 2023

The timeline of the two upcoming models could be pushed back if Congress doesn’t come to a funding agreement and the government shuts down, CMMI head Liz Fowler said.

Governance

Stopgap funding bill includes sweeping PBM reform, preserves telehealth flexibilities

Healthcare Dive

DECEMBER 18, 2024

Lawmakers Tuesday night released the full text of a bipartisan agreement to fund the government through March. It could also reshape the pharmacy supply chain by reforming how controversial drug middlemen do business.

Governance

Colorado first state to launch public option via federal waiver

Healthcare Dive

JUNE 24, 2022

Through the waiver granted by the CMS on Thursday, Colorado can use federal funds to set up a government-run health plan, a long-held progressive healthcare goal.

Governance

Providers urge HHS to clarify Change data breach reporting requirements

Healthcare Dive

MAY 21, 2024

More than 50 provider groups are asking the federal government to publicly state that UnitedHealth should handle data breach reporting stemming from the cyberattack on its subsidiary.

Governance

CMS should take stronger stance on hospital pricing compliance: GAO

Healthcare Dive

OCTOBER 4, 2024

The CMS fails to check hospitals’ pricing data for accuracy and completeness, raising questions about whether the data can be used as intended to help payers and patients shop for services, according to the government agency.

Hospitals

Hospitals Compliance Governance

Provider groups urge HHS, Congress to mitigate damage from Change cyberattack

Healthcare Dive

MARCH 5, 2024

The American Hospital Association and the American Medical Association pushed the federal government to offer more financial support as the outage limits providers’ ability to receive payment.

Governance

Governance Hospitals

Government watchdog warns of Medicaid oversight gaps

Federal government notches rare win in surprise billing lawsuit

Trending Sources

Government watchdog warns of Medicare fraud after relaxing provider requirements

Microsoft forms health AI governance network

HIPAA Compliance: Can Your Organization Avoid Costly Government Penalties and Fines?

Federal government probes healthcare private equity deals

Navigating government affairs in healthcare: Driving quality improvements

Insurer lobby blames government policies for 2025 Medicare Advantage market makeup

‘As fast as possible but no faster than is safe’: Hospitals, tech companies confront AI governance

HIPAA: Why It Matters to Your Practice

J&J sues federal government for halting 340B rebate plan

Major government ACOs to cover 13.2M people this year

J&J drops 340B rebate plan following government pressure

California’s data exchange framework proves government can do big things

Eight Opportunities to Use the Law to Address Social Determinants of Health

Managing Competing Government Data Requirements and Best Practices to Balance Sharing with Protection

By outfitting police with telehealth iPads, mental health program saves government $62M

NIST 2.0: Changes that Impact Cyber Programs and How Health Systems Can Adapt to the New ‘Govern’ Function

Government expects to recover more than $3B from healthcare fraud, misspent funds in fiscal year 2023

Seven Opportunities to Use the Law to Address Drug Policing

The public health emergency is over. Here’s why the government must prioritize funding for long COVID research.

HHS facing challenges as lead agency for healthcare cybersecurity: GAO

Private equity investing in healthcare continues to slow

Climate Change and Sexual and Reproductive Health and Rights in Africa: The Urgent Need for Intersectional Approaches in Climate Change Policy and Governance

How healthcare organizations should prepare for generative AI

California, Oregon eye universal health coverage

Judge questions surprise billing ban implementation during court hearing

National health spending reached $4.8T last year, CMS actuaries estimate

Uninsured rate expected to hit 8.9% over next decade, CBO finds

Omnibus bill restarts Medicaid checks, lowers Medicare physician pay cuts

CMS rolls out provider flexibilities amid fallout from Change cyberattack

Walgreens settles allegations of fraudulent billing with DOJ

National health spending reached $4.3 trillion in 2021

Book Review: ‘The Truth Pill: The Myth of Drug Regulation in India’

ONC head Micky Tripathi on info-blocking complaints, provider penalties and future of TEFCA

Microsoft’s health VP takes on responsible AI

State Medicaid spending fell below pre-pandemic levels during continuous enrollment

MACPAC wants Congress to force states to disclose Medicaid financing streams

CMMI teases new behavioral, maternal health models launching this year

Stopgap funding bill includes sweeping PBM reform, preserves telehealth flexibilities

Colorado first state to launch public option via federal waiver

Providers urge HHS to clarify Change data breach reporting requirements

CMS should take stronger stance on hospital pricing compliance: GAO

Provider groups urge HHS, Congress to mitigate damage from Change cyberattack

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