Compliant Health Care Solutions

AI And Risk Adjustment Abuse: A Double-Edged Sword An area particular concern is the potential for AI to exacerbate existing problems of risk adjustment abuse. AI, while promising for improving efficiency and patient care, could inadvertently amplify the risk of improper coding and inflated payments in Medicare Advantage (MA) programs. If not carefully implemented and monitored, AI algorithms could perpetuate biases present in historical data, leading to discriminatory outcomes and increased healthcare costs. Click the link below to read the full article.

5 Key Antitrust Takeaways From Holland & Knight's Panel At Nashville Healthcare Sessions 2024 2024 has been an eventful year for federal and state antitrust enforcement in healthcare with many in the industry wondering where do we go from here in 2025. Holland & Knight sponsored a breakout panel discussion at the recent Nashville Healthcare Sessions to bring down the temperature and provide an opportunity for the industry to learn about the latest developments directly from current and former federal officials and antitrust professionals. Click the link below to read the full article.

A Glimpse Into HHS’ Top Budget Priorities for 2025 The Department of Health and Human Services is on a mission to modernize, and its budget proposal for fiscal year 2025 — which includes $1.7 trillion in mandatory proposed budget authority and $130.7 billion in discretionary funding — reflects its aggressive pursuit of key transformation goals. Click the link below to read the complete article.

LLMs show potential for hospital quality measure reporting Large language models, or LLMs, can accurately process hospital quality measures efficiently and with high accuracy, according to the results of a pilot reported in the New England Journal of Medicine AI. Click the link below to read the complete article.

US Supreme Court Declines To Consider AKS 'Willfulness' Question On October 7, the US Supreme Court denied a petition in which a whistleblower asked the Court to decide whether a "willful" act under the federal Anti-Kickback Statute (AKS) requires that a defendant knew their actions violated the law. Click the link below to read the full article.

HHS, NIST conference: Collaboration is key in healthcare cyber Officials from HHS, the National Institute of Standards and Technology and other agencies stressed the role of collaboration in improving healthcare cybersecurity throughout the first day of the Safeguarding Health Information: Building Assurance through HIPAA Security 2024 conference, hosted by the HHS Office for Civil Rights and the NIST Information Technology Laboratory in Washington. Click the link below to read the complete article.

Medicare Coverage: CMS Finalizes New Pathway For Breakthrough Devices The Centers for Medicare & Medicaid Services (CMS) released a Final Notice for Transitional Coverage for Emerging Technologies (TCET), effective August 12, 2024, to provide "transparent, predictable, and expedited national coverage" for eligible devices designated as "breakthrough devices" by the U.S. Food & Drug Administration (FDA). Click the link below to read the full article.

Fault Lines Expected To Deepen: Major False Claims Act Circuit Split The health care industry is anxiously awaiting the First Circuit's ruling on the standard of causation for actions brought under the False Claims Act (FCA) predicated on a federal Anti-Kickback Statute (AKS) violation. The First Circuit will decide whether the FCA "result[s] from" a kickback if that claim would not have included the items or services payable by a federal health care program (FHCP) "but-for" such kickback. Click the link below to read the full article.

A Practical Review: Welcome To The Party — CMS And TJC Finally Allow Critical Access Hospitals To Unify Medical Staffs With Acute Care Hospitals Floating under the radar of a series of regulatory changes governing the operation of CAHs over the last eighteen months was a significant shift in the regulations governing the relationship between the medical staffs of CAHs ... Click the link below to read the full article.

Understanding hospital billing for cardiac PET/CT Hospital billing for cardiac positron emission tomography (PET) imaging can be a challenging topic, even for experienced specialists. To help provide some clarity, the American Society of Nuclear Cardiology (ASNC) made billing for cardiac PET the focus of a presentating during its 2024 annual meeting. Click the link below to read the full story.