Due diligence is a vital step in all types of mergers, acquisitions, and other transactions, including making large investments in a company (collectively referred to...

In the utilization management world, the adoption of CMS-4201-F—the new rule regulating many Medicare Advantage (MA) plan activities—was a game changer.[1] Like many new rules,...

The False Claims Act (FCA) permits private individuals to bring lawsuits in the name of the United States—called qui tam—against those they believe have defrauded...

Organizations often struggle to navigate the fine line between research activities and quality improvement activities. This can be complicated by a lack of coordination between...

In November 2023, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released the General Compliance Program Guidance (GCPG). The...

Mergers and acquisitions (M&A) constantly occur in the healthcare industry. Organizations have varying levels of compliance involvement in the “due diligence” phase. During due diligence,...

On April 26, 2024, the U.S. Department of Health and Human Service Office for Civil Rights issued a final privacy rule to support reproductive health...

In February 2000, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published a Special Fraud Alert, “Rental of Space in...