For Medicare contract sponsors to remain viable, it's now necessary to perform a comprehensive Medicare program compliance review. Proposed rule changes may give CMS additional authority next year.

The New York State Office of the Medicaid Inspector General (“OMIG”) issued a Listserv Notice on June 26, 2025 advising that its Compliance Program Reviews (“CPRs”) beginning after July 1, 2025, will ...

Hospitals must submit subsequent provider-based attestations for each off-campus outpatient department on a periodic basis ...

With agencies dueling to regulate nursing homes, aligning priorities for a strategic compliance program may be more challenging than ever.

The 2024 Medicare Advantage Final Rule changed inpatient coverage, requiring healthcare providers to reevaluate their patient strategies. Unlike traditional Medicare Part A, Medicare Advantage (MA) ...

CMS has announced it will “pause” additional documentation requests from Medicare recovery audit contractors as the agency procures the next round of RAC contracts. The pause in operations will allow ...

Angela Palo is COO of Pinnacle Financial Services, a leading National Medicare Brokerage, and member of the NABIP Medicare FMO Council. Medicare agencies and brokers juggle lead pipelines, sales ...