Deregulating AI in healthcare doesn’t eliminate compliance risk—it amplifies it. From data bias and transparency issues to patient safety and legal liability, the absence of clear standards places greater responsibility on internal governance. Compliance professionals must prepare for a future where proactive oversight, not regulation, is the first line of defense.

The One Big Beautiful Bill Act has passed—and with it comes sweeping changes for healthcare providers and health plans. From Medicaid work requirements to expanded audits and Medicare cuts, the compliance implications are real and immediate. This blog breaks down what’s changed, who’s impacted, and what to do next to prepare your organization. Don’t wait to get ahead of the curve—read the full breakdown now.

CMS has proposed a 6.4% cut to home health payments in 2026—totaling $1.13 billion. The rule includes PDGM recalibrations, reporting changes, and temporary reductions CMS claims are needed to offset overpayments. Industry leaders warn of devastating consequences for access and agency viability. Compliance teams should act now with financial modeling, documentation audits, and reporting updates to prepare.

CMS’s Medicaid tax rule marks a shift from formula-driven compliance to subjective scrutiny. States must now justify provider tax structures beyond passing statistical tests—anticipating CMS’s interpretations and preparing for deeper documentation, broader collaboration, and potential delays. For compliance leaders, this is a call to move beyond checklists and embrace strategic, cross-functional oversight in a changing regulatory landscape.

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 Medicaid tax rule aims to safeguard federal funds—but could it unintentionally harm access and equity? Reduced benefits, strained provider reimbursements, and risks to immigrant health programs are real concerns. Compliance professionals must assess the impact, monitor equity metrics, and advocate for policies that protect vulnerable communities while upholding Medicaid’s integrity.

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’s proposed Medicaid tax rule may reshape the environment for Managed Care Organizations. While MCOs aren’t directly regulated by the rule, its impact on state tax structures could bring financial pressure, contract uncertainty, and participation risks. Compliance leaders at MCOs should prepare for shifting rates, increased scrutiny, and evolving state financing strategies as Medicaid’s landscape continues to change.

CMS’s proposed Medicaid tax rule may hit states in different ways. Expansion states risk losing key funding streams that support their broader coverage models, while non-expansion states face fewer immediate threats—but may see limits on future flexibility. For compliance leaders, the challenge is navigating divergent impacts, assessing funding models, and preparing for policy shifts that could reshape Medicaid’s landscape nationwide.

CMS’s proposed Medicaid tax rule highlights growing tension between federal oversight and state flexibility. While aimed at curbing provider tax loopholes, the rule signals a shift in power—limiting state innovation and increasing CMS discretion. Compliance leaders should assess risk, engage with state Medicaid agencies, and monitor enforcement trends as this debate reshapes Medicaid financing.

CMS’s proposed Medicaid tax rule could make it harder for states to fund health coverage for undocumented immigrants and others excluded from federal Medicaid. By penalizing certain tax structures, CMS risks limiting state innovation and reducing access to care for vulnerable populations. Compliance leaders should watch for policy shifts, fiscal changes, and impacts on health equity as this debate unfolds.

CMS’s proposed rule on Medicaid provider taxes could close a costly loophole—but not without big implications for states, providers, and vulnerable populations. The rule aims to curb tax schemes that maximize federal funds, yet critics warn it may reduce state flexibility, impact nonprofit providers, and add compliance complexity. Compliance leaders should monitor developments and engage with state agencies now.

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.

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