Compliance & Legal

Rad AI CIO Demetri Giannikopoulos recommends that new AI tools be tested and monitored in sandbox environments before clinical deployment.

Jonathan French, HIMSS' senior director of public policy, explains how the CMS Health Tech Ecosystem and ONC's HTI-5 Proposed Rule may reshape interoperability policy and regulation for digital health tools.

The complaint alleged corruption by HaloMD, a company that handles the arbitration process for medical billing disputes.

Nineteen states and D.C. are seeking to invalidate a March 2025 directive to reduce the number of HHS employees and eliminate several sub-agencies.

Aetna's policy results in denials and underpayment and violates CMS' Two Midnight Rule, the health system says.

The hospitals want DSH calculations changed back to a pre-2004 standard and payment of additional amounts, plus interest.

The large New York City hospital system used its market power to restrict contacts with insurers, insulating it from price competition, or "erosion of rates of payment," says DOJ.

FTC reached a settlement with Express Scripts in February and is currently in negotiations with OptumRx.

The task force may expand to include HHS and DOJ members in an integrated approach to enforcement and to preserve competition, FTC says.

CMS is leveraging AI and machine learning to flag possible Medicare and Medicaid fraud. However, COO Kimberly Brandt says experts like clinicians and forensic accountants are needed to verify their findings before action is taken.