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Recent Blogs

Audit Expectations and Challenges

When it comes to hospitals providing best-in-class health care, stress comes with the territory. From stabilizing trauma victims, to accurately distributing medications, to physicians and

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Jerry Shafran February 21, 2020

Blogs by Category

Compliance and Business Strategy
21 May 2025
Four Ways to Integrate Compliance with Safety/Quality Efforts 
Traditionally, many healthcare compliance programs have left the work of patient safety and quality to other departments....
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06 May 2025
Beyond the Checklist: Integrate Compliance into Everyday Operations 
"Compliance in healthcare isn’t just about meeting regulatory requirements – it’s about protecting patients, maintaining...
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22 April 2025
Ditch the "Department of No" & Embrace the Business of Compliance 
"Being a healthcare compliance professional involves navigating a complex landscape where law, risk, operations,...
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16 April 2025
Best Practices for Documenting Compliance Training in Healthcare 
There have been many times where we have talked to auditors or inspectors who wanted to know if training occurred....
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09 April 2025
Integrate Self-Awareness into Healthcare Compliance Programs: 18 Tips 
As compliance officers, we spend a lot of time focused on how others perform their jobs. However, being self-aware...
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27 March 2025
Healthcare Audit? Stay Ready. Don’t Get Ready. 
"Audit readiness in quality is no different than anything else – follow a pre-defined process to the letter, tweak...
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18 March 2025
What Happens When Integrity and Accountability Fail: Lessons for Compliance Professionals 
"The U.S. opioid epidemic holds important lessons for compliance professionals. This public health crisis is characterized...
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28 January 2025
Managing Healthcare Compliance is like Juggling Chainsaws
“Managing priorities, like juggling chainsaws, requires not just courage, but a deep respect for the risks and rewards...
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09 October 2024
For the Love of the Game: Fourth Quarter Compliance Strategies 
“As we get underway in the Fourth Quarter, both football coaches and Compliance Officers must be prepared to take...
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18 September 2024
How to Use TPE Plans for Compliance Auditing and Monitoring 
“There’s another incredibly helpful resource that some might not be as familiar with: the list of services that...
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20 August 2024
Five Tips for Making Better Compliance Decisions 
“Whether you're resolving a complex billing issue, or advising your leadership team about a business proposal, the...
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16 July 2024
Revenue Cycle Management Compliance: Ensuring Financial Health in Healthcare 
“Revenue cycle management compliance is crucial for the financial health and operational success of healthcare providers....
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09 July 2024
Experts Weigh In: The Oversight Role of a Healthcare Board of Directors 
“Whether you are new to the field or a seasoned professional, hopefully the viewpoints offer insight that can influence...
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21 May 2024
One Compliance Pro’s Regulatory Change Management Process   
“A clear, structured, and methodical approach to compliance will help professionals navigate regulatory change....
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18 March 2024
The Cost of Non-Compliance 
“The cost of non-compliance in healthcare extends far beyond fines and penalties. It encompasses legal fees, reputational...
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Compliance Career Tips
04 June 2025
Aggressive vs Assertive Communication: What New Healthcare Compliance Officers Need to Know 
"When it comes to the compliance program, effective communication is essential for building strong relationships,...
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29 May 2025
Best Practices for Better Training in Healthcare Compliance 
"Maintaining quality in compliance training is a constant challenge for healthcare organizations of all sizes. Any...
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14 May 2025
How Storytelling Improves Compliance Communication and Training 
"It’s really simple – people get hooked on stories, and the tales stick with us.  For example, once upon a time,...
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06 May 2025
Beyond the Checklist: Integrate Compliance into Everyday Operations 
"Compliance in healthcare isn’t just about meeting regulatory requirements – it’s about protecting patients, maintaining...
Read More
22 April 2025
Ditch the "Department of No" & Embrace the Business of Compliance 
"Being a healthcare compliance professional involves navigating a complex landscape where law, risk, operations,...
Read More
16 April 2025
Best Practices for Documenting Compliance Training in Healthcare 
There have been many times where we have talked to auditors or inspectors who wanted to know if training occurred....
Read More
09 April 2025
Integrate Self-Awareness into Healthcare Compliance Programs: 18 Tips 
As compliance officers, we spend a lot of time focused on how others perform their jobs. However, being self-aware...
Read More
18 March 2025
What Happens When Integrity and Accountability Fail: Lessons for Compliance Professionals 
"The U.S. opioid epidemic holds important lessons for compliance professionals. This public health crisis is characterized...
Read More
11 March 2025
New Regulation– Now What? Step-by-Step Guide to Managing Compliance Changes 
"With regulations often spanning hundreds of pages, how can compliance teams efficiently manage the process without...
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26 February 2025
Healthcare Compliance Readiness: Do What’s Doable 
“Any discussion or plan that doesn’t take into account whether or not you can actually execute on it is an exercise...
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11 February 2025
Navigating Compliance Responsibility: A Foundation for Compliance Program Success 
“Healthcare compliance professionals face significant challenges when managing who is responsible for completing...
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28 January 2025
Managing Healthcare Compliance is like Juggling Chainsaws
“Managing priorities, like juggling chainsaws, requires not just courage, but a deep respect for the risks and rewards...
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15 January 2025
Five Strategies for Aligning Human Behavior With Your Compliance Program
“Compliance work is complex, and success in compliance requires human interaction. By understanding the psychological...
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19 November 2024
How Slowing Down Makes for a More Productive Compliance Program
“As regulations change or investigations are needed, we often get pushed to work faster, meet tighter deadlines,...
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30 October 2024
Ensuring Compliance for Academic Medical Centers 
“The U.S. government has recently increased its focus on foreign influence in academic research – which some call...
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Compliance Culture
04 June 2025
Aggressive vs Assertive Communication: What New Healthcare Compliance Officers Need to Know 
"When it comes to the compliance program, effective communication is essential for building strong relationships,...
Read More
14 May 2025
How Storytelling Improves Compliance Communication and Training 
"It’s really simple – people get hooked on stories, and the tales stick with us.  For example, once upon a time,...
Read More
15 January 2025
Five Strategies for Aligning Human Behavior With Your Compliance Program
“Compliance work is complex, and success in compliance requires human interaction. By understanding the psychological...
Read More
19 November 2024
How Slowing Down Makes for a More Productive Compliance Program
“As regulations change or investigations are needed, we often get pushed to work faster, meet tighter deadlines,...
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23 October 2024
Compliance Leadership Diversity is Key: Legal, Business, and Clinical Backgrounds 
“No single background has all the answers, but by combining the strengths of these diverse perspectives, healthcare...
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04 September 2024
Building the Three C’s of Compliance: Competence, Credibility, and Collaboration 
“Compliance is not just about enforcing rules – it is about guiding your organization towards a culture of integrity...
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13 August 2024
Next Jen: The Value of Compliance Programs and Teams 
“Rather than limiting the breadth and scope of your compliance program to what is minimally required by regulators,...
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23 July 2024
When Compliance is the Problem: “Us” Versus “Them”  
“By bridging the gap between “us” and “them,” compliance teams can transform the perception of compliance teams...
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19 June 2024
I Got the Compliance Job! Now What? 
“During that first interview of mine, the interviewer told me, “I need someone who can build relationships, is strategic...
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29 May 2024
Tips for Handling Tough Feedback
“Handling tough feedback is never easy, and quickly challenges your ability to remain professional. With the right...
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28 February 2024
Tips for Overcoming Four Common Blind Spots in Communication
“Falling victim to communications blind spots can damage your relationships with healthcare leaders and contradict...
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25 October 2023
Reversing Conventional Thinking About Compliance  
Explore how compliance professionals can prove their true value in organizations, dispel misconceptions, and effectively...
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05 October 2023
How to Make a Compliance Culture Contagious 
“In the business of healthcare, promoting a culture of compliance is not merely a goal – it's a necessity. There...
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20 September 2023
Three Ways to Take a Service-Minded Approach to Compliance
“We’re continually being asked for advice to help our healthcare leaders. Essentially, we are acting as a customer...
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16 August 2023
How to Sell Compliance without “Selling” Compliance  
If we want to improve our organizations’ compliance culture, then we need to interact with our healthcare leaders...
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Industry Trends
04 February 2025
Breaking Down the OIG’s First Industry-Specific Guidance 
“Compliance professionals at nursing facilities and their business partners should regularly study the ICPG as they...
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18 December 2024
Recapping 2024 and Ringing In 2025 
CEO Jerry Shafran has prepared a festive video to help us wrap up the year. We wish you a safe and happy Holidays...
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09 July 2024
Experts Weigh In: The Oversight Role of a Healthcare Board of Directors 
“Whether you are new to the field or a seasoned professional, hopefully the viewpoints offer insight that can influence...
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13 February 2024
The ABC’s of Integrating AI Into Your Compliance Strategy 
“By taking a practical approach to this complex topic, you will be viewed positively by your team and able to respond...
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02 January 2024
How the OIG’s New General Compliance Program Guidance (GCPG) Addresses the Seven Elements  
“Compliance officers can make the most of the new GCPG to meet the requirements of the OIG’s seven elements in a...
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19 December 2023
Key Takeaways from OIG’s New General Compliance Program Guidance (GCPG) 
“Throughout the GCPG, helpful revisions and clarity are provided to a few areas that have proven problematic over...
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11 December 2023
Key Takeaways from OIG’s Newly Released General Compliance Program Guidance 
“Successful compliance programs are adapted to fit the organization and maximize compliance for individual organizations...
Read More
29 November 2023
Key Takeaways from OIG’s New General Compliance Program Guidance (GCPG) 
“Throughout the GCPG, helpful revisions and clarity are provided to a few areas that have proven problematic over...
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15 November 2023
Mitigating Risks from Online Tracking Technologies 
“To protect patients’ privacy and adhere to federal law, compliance professionals must understand what online patient...
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22 August 2023
Significant Upcoding Risks Emerge with Medicare Advantage
Christi Grimm, the Inspector General of HHS, gave a recent keynote address to compliance professionals. In it, she...
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12 April 2023
New DOJ Guidance on Compliance Programs Released March 2023
Healthcare organizations should benchmark the DOJ Evaluation of Corporate Compliance Programs (ECCP) guidance (March...
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29 March 2023
Preparing for the End of the Public Health Emergency
Changes to PHE waivers and recommendations for hospitals. Compliance must assist and advise on policy, process,...
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01 March 2023
The Three Lines Model for Healthcare Compliance  
Show that healthcare compliance and operations share responsibility for identifying and mitigating risks with the...
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18 January 2023
Federal and State Agencies Preview 2023 Enforcement Trends
The MHA's Healthcare Legal Compliance Forum Federal and State Enforcement Update in Dec. 2022 looks at Stark law...
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02 August 2022
COVID-related enforcement actions 
Trillions spent through the COVID public health emergency drive audit and enforcement actions from the government....
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Revenue Cycle
Rules and Regulations
31 July 2024
How to Avoid False Claims Related to Medical Necessity  
“There is no silver bullet to solving medical necessity risks as they relate to medical claims submitted to payers...
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16 July 2024
Revenue Cycle Management Compliance: Ensuring Financial Health in Healthcare 
“Revenue cycle management compliance is crucial for the financial health and operational success of healthcare providers....
Read More
12 July 2023
Uncovering $9 Million in Unbilled Services   
“My success in uncovering millions of dollars in unbilled services demonstrates how revenue protection is a tangible...
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22 March 2023
Healthcare Compliance Risks with Urine Drug Testing Overpayments
Urine drug testing overpayments drove up to $216 million in overpayments to Medicare over five years, according...
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22 February 2023
Compliance Risks Associated with Outlier Payments 
Protect healthcare revenue: reduce the risk of fines and payback for inappropriate outlier payments created by unjustified...
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14 December 2022
Healthcare Compliance is Everybody’s Business: Clinical, Revenue Cycle, IT, Sales and Marketing
Build relationships with these key clinical and operational areas - Nursing, Physicians, Revenue Cycle, IT, Sales...
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09 November 2022
Critical Care Services Under the Microscope 
Complex and billed at a higher rate, OIG added physicians billing for critical care evaluation and management services...
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26 October 2022
A million-dollar healthcare compliance monitoring mistake 
Avoid this million-dollar monitoring mistake. Help clinical colleagues apply their expertise to your scalable, repeatable...
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11 May 2022
Physician Coding and Billing Enforcement: What to Watch For
CJ Wolf, MD writes enforcement action summaries for the YouCompli blog. These summaries provide real-world examples...
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13 April 2022
Beneficiary inducements…don’t cross that line
Illegal beneficiary inducements include: free insulin, deflated Medicare copayment, courtesy adjustments for injections,...
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16 February 2022
Avoiding up to $1.5 million a year in Privacy Rule penalties may be easier than you think.
Avoid up to $1.5M a year in Privacy Rule penalties and investigations. Information blocking oversight team for effective...
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05 January 2022
Get ready to comply with strict new privacy regs [or pay big fines]
New rules from the Health and Human Services (HHS) department put stricter guardrails on how and when healthcare...
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05 June 2020
Protecting Hospital Finances in the Post-Pandemic Environment
It’s become a cliche, especially in healthcare, to say that COVID-19 has changed “everything”....
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24 April 2020
5 Payer Audit Errors Every Hospital Must Avoid
Revised September 2022 Most healthcare providers, from large hospitals to solo practitioners, experience an external...
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27 March 2025
Healthcare Audit? Stay Ready. Don’t Get Ready. 
"Audit readiness in quality is no different than anything else – follow a pre-defined process to the letter, tweak...
Read More
18 March 2025
What Happens When Integrity and Accountability Fail: Lessons for Compliance Professionals 
"The U.S. opioid epidemic holds important lessons for compliance professionals. This public health crisis is characterized...
Read More
11 March 2025
New Regulation– Now What? Step-by-Step Guide to Managing Compliance Changes 
"With regulations often spanning hundreds of pages, how can compliance teams efficiently manage the process without...
Read More
04 February 2025
Breaking Down the OIG’s First Industry-Specific Guidance 
“Compliance professionals at nursing facilities and their business partners should regularly study the ICPG as they...
Read More
10 December 2024
The HIPAA Reproductive Health Rule: A Potential Plot Twist 
“With Donald J. Trump set to return to the White House in January, the healthcare industry should expect to see...
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03 December 2024
Building a Quality Education Program That’s Good Enough 
“The first thing that you should understand is this: you don’t have to build the perfect program. Your education...
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16 October 2024
Ensuring Compliance for Radiology Services 
“Radiology services have unique characteristics, and some unique compliance considerations that accompany them include...
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18 September 2024
How to Use TPE Plans for Compliance Auditing and Monitoring 
“There’s another incredibly helpful resource that some might not be as familiar with: the list of services that...
Read More
31 July 2024
How to Avoid False Claims Related to Medical Necessity  
“There is no silver bullet to solving medical necessity risks as they relate to medical claims submitted to payers...
Read More
23 April 2024
How to Properly Use the G2211 Evaluation and Management Code 
“Code G2211, which can be added to specific E/M codes under certain circumstances, is now separately reimbursable...
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02 January 2024
How the OIG’s New General Compliance Program Guidance (GCPG) Addresses the Seven Elements  
“Compliance officers can make the most of the new GCPG to meet the requirements of the OIG’s seven elements in a...
Read More
19 December 2023
Key Takeaways from OIG’s New General Compliance Program Guidance (GCPG) 
“Throughout the GCPG, helpful revisions and clarity are provided to a few areas that have proven problematic over...
Read More
11 December 2023
Key Takeaways from OIG’s Newly Released General Compliance Program Guidance 
“Successful compliance programs are adapted to fit the organization and maximize compliance for individual organizations...
Read More
29 November 2023
Key Takeaways from OIG’s New General Compliance Program Guidance (GCPG) 
“Throughout the GCPG, helpful revisions and clarity are provided to a few areas that have proven problematic over...
Read More
17 October 2023
New, Stronger Evaluation and Management Upcoding Enforcement 
“Earlier this year, regulators made the most significant changes to E&M documentation and coding guidelines in over...
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