Compliagent

Compliagent is a Los Angeles‐based regulatory consulting firm serving healthcare providers nationally. We'll get you in compliance. And keep you there.

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Wound care providers: Review CMS's new skin substitute payment methodology and ensure billing reflects medical necessity requirements. https://t.co/GHwf2vMPrA

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CMS cuts skin substitute reimbursement by 90% effective Jan 2026, reducing Medicare spending $19.6B while targeting fraud and abuse. https://t.co/1Cxq2coRCX

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Ransomware attacks are increasing. Is your organization conducting accurate HIPAA Security Rule risk analyses and breach response planning? https://t.co/GHwf2vMPrA

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Covenant Health reports ransomware breach affecting 478,000 patients with Qilin group publishing stolen data including SSNs and treatment records. https://t.co/1Cxq2coRCX

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Digital health developers: Review FDA's updated CDS and general wellness guidance for your AI-enabled medical software compliance. https://t.co/GHwf2vMPrA

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FDA revises CDS software guidance expanding exemptions and enforcement discretion for AI-enabled health applications effective January 2026. https://t.co/1Cxq2coRCX

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Pharmaceutical manufacturers: Review CMS's GUARD Model proposal affecting Part D pricing. Comments due February 23, 2026. https://t.co/GHwf2vMPrA

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CMS proposes mandatory GUARD Model to reduce Medicare Part D drug costs using international pricing benchmarks starting 2027. https://t.co/1Cxq2coRCX

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Is your billing for wound care services medically necessary and properly documented? DOJ is aggressively pursuing fraud schemes. https://t.co/GHwf2vMPrA

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DOJ announces $309M settlement with Apex Medical owners for medically unnecessary wound grafts targeting hospice patients. https://t.co/1Cxq2coRCX

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Healthcare organizations should implement robust compliance programs, conduct internal audits, and document cooperation efforts to mitigate False Claims Act exposure. https://t.co/GHwf2vMPrA

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DOJ reports record $6.8B in FCA recoveries for FY 2025, with healthcare accounting for $5.7B and whistleblowers filing record 1,297 new qui tam lawsuits. https://t.co/1Cxq2coRCX

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Healthcare providers must respond to patient record requests within 30 days (plus one 30-day extension if needed) to avoid HIPAA Right of Access violations. https://t.co/GHwf2vMPrA

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OCR settles 54th Right of Access enforcement action with Concentra for $112,500 after individual made six requests over one year without receiving records. https://t.co/1Cxq2coRCX

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Wound care providers must ensure EHR and billing software accurately reflect actual services provided and do not automatically upcode to higher reimbursement levels. https://t.co/GHwf2vMPrA

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DOJ announces $45M settlement with Vohra Wound Physicians for alleged medically unnecessary procedures and EHR manipulation to upcode wound care billing. https://t.co/1Cxq2coRCX

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Nursing homes must maintain accurate facility assessments and staff to meet actual resident needs based on acuity, even without numerical minimums. https://t.co/GHwf2vMPrA

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CMS repeals nursing home minimum staffing requirements (3.48 hours/resident/day, 24/7 RN) effective February 2, 2026, reverting to 8-hour RN minimum. https://t.co/1Cxq2coRCX

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Medicare Advantage plans must ensure diagnosis codes are clinically supported at time of service and avoid linking physician compensation to risk adjustment scores. https://t.co/GHwf2vMPrA

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DOJ announces record $556M Medicare Advantage settlement with Kaiser Permanente for alleged upcoding scheme through retrospective chart addenda from 2009-2018. https://t.co/1Cxq2coRCX