Ep. 66 – Mid-year compliance check-in: three new enforcement priorities to add to your 2025 work plan

As we hit the halfway point of 2025, now is the perfect time to revisit your compliance work plan. While it’s always good practice to assess whether your organization is meeting its compliance goals, this year presents a unique challenge due to shifting federal enforcement priorities under the new administration.

Healthcare organizations should evaluate three newly emerging risk areas and consider incorporating them into their compliance work plans.

1. DEI Programs and False Claims Act Risk

The Department of Justice (DOJ) recently launched a Civil Rights Fraud Initiative aimed at investigating whether federally funded organizations—including Medicare and Medicaid providers—are violating civil rights laws. DEI (Diversity, Equity, and Inclusion) programs are now under scrutiny, with the DOJ signaling potential False Claims Act enforcement for programs they deem discriminatory or unlawful. Even providers without formal DEI programs should evaluate any policies or practices that could be interpreted as discriminatory. It’s also important to ensure that your compliance reporting channels are equipped to handle potential discrimination complaints.

2. Gender-Affirming Care Under Scrutiny

Federal enforcement efforts are also focusing on gender-affirming care, especially services provided to minors. This includes investigating potential misuse of Medicaid billing codes and off-label hormone treatments. Providers should work closely with legal counsel to identify what gender-affirming care they provide, review applicable state laws, and monitor any evolving federal guidance. If your organization offers such services—especially to minors—this issue should be added to your compliance risk assessment.

3. Federal Grants and Other Financial Assistance

Finally, compliance leaders must not overlook grants and other forms of federal financial assistance their organization receives. These funds often come with certifications of compliance with federal laws—including executive orders. Violations of DEI or gender-affirming care policies could lead to not just a loss of funding, but potential False Claims Act liability due to an alleged false certification. Review all federal assistance programs your organization participates in and confirm your compliance with their terms and conditions.

Takeaway:
Update your compliance work plan now to reflect these priorities. Assign someone internally to monitor developments related to DEI and gender-affirming care, and ensure you’re in full compliance not only with Medicare and Medicaid requirements but also with any grant or other federal funding obligations. Being proactive can help your organization avoid significant regulatory risk in this evolving landscape.