The 2024 Marketplace Final Rule aims to strengthen enrollment integrity, expand affordability, and advance health equity—but it also introduces new compliance risks that could impact access and operations. This post breaks down what’s changing, who could be affected, and how compliance professionals can stay ahead.

CMS’s 2026 Final Rule brings big changes to Medicare Advantage and Part D—including stronger inpatient review rules, codified cost-sharing caps, expanded appeals rights, and tighter audit protocols. Compliance is no longer optional—these updates are now mandatory. Read on for key takeaways and practical steps your team can take to prepare.

CMS just announced a sweeping expansion of its RADV audit strategy, shifting from ~60 annual reviews to audits of every eligible Medicare Advantage plan, every year. With increased sample sizes, a 50x workforce expansion, and AI-powered diagnostics review, the message is clear: audits are no longer an exception—they’re the norm. Learn what this means and how Simply Compliance helps organizations prepare.

At the heart of the Chevron decision and its repeal is the debate over whether agencies have the authority to issue and enforce...

·        Updated Website Resources on DHS Website: Crucial for understanding the responsibilities of Managed Care Organizations (MCOs),...

1.        New  quality measure for Electronic Visit Verification (EVV) includes having no more than 15% manual edits starting January 1,...

Written by Jessica Zeff @ Simply Compliance www.simplycomplianceconsulting.com Introduction The Health and Human Services (HHS) issued a...

The final rule introduces significant modifications focusing on enhancing protections for reproductive health care: 1. Prohibited Uses...

The recent modifications to HIPAA, specifically targeting information sharing for reproductive health care, have stirred significant...

In the healthcare sector, the significance of privacy teams has evolved into a cornerstone of organizational integrity and operational...

Understanding Medicare's Billing Requirements Medicare's billing regulations differentiate significantly between Annual Wellness Visits...

The healthcare industry, particularly mental and behavioral health sectors, often grapples with the daunting challenges of regulatory...

In the realm of healthcare, artificial intelligence (AI) promises enhanced diagnostic precision and therapeutic efficacy. However, the...

As of April 1st, CMS revised its informed consent requirements for sensitive procedures and OCR has released updated FAQs.  In light of...

Online tracking technologies refer to scripts or codes on websites or mobile applications used to gather information about how users...

The Centers for Medicare & Medicaid Services (CMS) has just released the FY2025 Hospice Payment Rate Update Proposed Rule. Here is a...

The Prior Authorization Final Rule introduces a modern approach to expedite prior authorization processes. This initiative primarily...

In the digital age, the intersection of artificial intelligence (AI) and human rights has become an increasingly pressing issue. The...

In a significant cybersecurity event, Change Healthcare, a prominent provider of healthcare technology services, suffered a cyberattack....