New price transparency requirements take effect July 1 on the shoulders of other requirements that should have been met Jan. 1. With another deadline looming, hospitals may want to take advantage of CMS’s new online validator,^[1] which allows them to determine whether their machine-readable files (MRF) are in good shape. The stakes are high because CMS is taking enforcement seriously. It has already reviewed compliance with price transparency requirements at thousands of hospitals.

“No one is safe from being placed under the microscope,” said Martie Ross, a consulting principal with PYA, at its April 24 webinar.

In two new cases, federal courts have ruled that providers are entitled to all the documentation used by CMS and its program integrity contractors to calculate overpayments, which is a win for providers pushing back on extrapolation, an attorney said. But one court concluded that Medicare auditors aren’t required to include zero-paid claims in the “target universe” of claims, which can affect the fate of the statistically valid random sampling and extrapolation, and the other court hasn’t ruled yet on the inclusion of zero-paid claims.

They are cases of “first impression,” which means they’re the first time that federal courts have ruled providers have a due process right to compel completion of the administrative record, said attorney Stephen Bittinger, with K&L Gates, who represented the providers in the cases.

The list below appears in the Society of Corporate Compliance and Ethics’ The Complete Compliance and Ethics Manual 2024.^[1]

A final HIPAA rule on reproductive health care privacy prohibits covered entities from disclosing reproductive health care information to law enforcement agencies, with an exception.^[1] The HHS Office for Civil Rights (OCR) released the rule April 22, two days before the U.S. Supreme Court heard oral arguments on whether Idaho’s abortion ban violates the Emergency Medical Treatment and Labor Act (EMTALA)—events that have pushed abortion deeper into the compliance realm.^[2]

General use of artificial intelligence (AI) became available through OpenAI’s introduction of ChatGPT—a chatbot—on November 30, 2022. This led to broader public adoption of the technology, quickly reaching 100 million users in two months.^[1] However, the quick uptake and pace of AI development had led to concerns and calls for global generative AI regulation by the CEO of ChatGPT in 2023 during congressional testimony.^[2]