Compliance Stuff

How in-depth has your entity reviewed its third-party payor agreements? Have your billing team, Compliance Officer, Privacy Officer, and Legal team all been made aware of requirements or, better yet, were they involved in the agreements' approval? Navigating the “fine print” in payor agreements can be the difference between a smooth operation and a compliance nightmare. Here are five critical areas where providers often get tripped up—and what you should be asking your team right now. Breach Notification Requirements Some provider agreements require that entities notify the payor within 24 hours of a Health Insurance Portability and Accountability Act (HIPAA) breach . While often unrealistic, it's a standard clause that frequently lacks clarity as to whether an unsuccessful security penetration attempt must be reported. The Checkup:  Have you determined what your reporting requirements are? Have you implemented a process to meet those requirements? Change of Ownership or Cont...

Providers that rely on telehealth for Medicare patients can continue to do so as a result of an extension of the Medicare telehealth rules that were originally implemented during the COVID-19 Public Health Emergency (“COVID”). On February 3, 2026, the Consolidated Appropriations Act, 2026, H.R. 7148 was signed into law and, among other features, extends key components of the emergency telehealth requirements and will continue to allow for increased provider eligibility, remote care from home and relaxed site-of-service, all rules upon which providers have extensively relied since COVID . CMS extended these rules in order to provide greater flexibility and remote health care access. Providers should be aware that this extension only will last through December 31, 2027, unless Congress puts a permanent solution in place. [ View source .] Source(s): Medicare Telehealth Expansion Continues Under New Federal Extension | JD Supra . (2026). JD Supra. https://www.jdsupra.com/legalnews/medicare...

2025 has been a landmark year for False Claims Act (FCA) enforcement, marked by record-breaking settlements, evolving legal theories, and a broadening scope of government priorities. The FCA remains one of the federal government’s most potent tools for combating fraud, with billions recovered annually and an ever-expanding reach into new sectors and compliance areas . This roundup synthesizes the year’s most significant developments—drawing on recent case law and shifting enforcement priorities—and provides actionable insights for businesses navigating the FCA landscape. Case Law Update: Constitutional Challenges and Qui Tam Relators In 2025, the constitutionality of the FCA’s qui tam provisions—which empower private litigants (relators) to prosecute fraud claims on the government’s behalf—continued to emerge as a focal point of judicial debate . Historically, federal courts, including the U.S. Court of Appeals for the Fifth, Sixth, Ninth, and Tenth Circuits, have rejected arguments ch...

  Illinois will soon require fully insured health policies issued in the state to cover parents and stepparents who qualify as dependents, and employers that sponsor these group health plans must take note. This expansion of the Illinois Insurance Code, which applies to policies issued, amended, delivered, or renewed after January 1, 2026, creates new administrative challenges and compliance obligations for group health plans – especially since they typically offer dependent benefits only to children and spouses or domestic partners. We’ll explain what’s changing, how it impacts employers, and what you should do next. A Significant Shift in Dependent Eligibility Gov. JB Pritzker signed a bill ( HB 5258 ) into law last year that will soon require accident and health insurance policies that provide dependent coverage to make that coverage available to any parent and stepparent who: has gross income that is less than the IRS exemption amount ($5,050 for 2025); receives a majority...