They don't care, they will just pay the fines and move on. No big deal. It's just $$
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And if you are a main contractor just subcontract to offshore. Works like shell LLC game nobody really knows where anything is. Most likely Philippines that is the hot spot of cheap labor India getting to pricy
They have trade agreements that each party signs and certify data is secure. No offshore restrictions of Medicare. I mean there probably should be, which is why we all think there is, but if you still want it affordable, then offshore is less expensive.
Wait until CMS discovers that patients medical records have been shipped overseas for years now, in direct violation of HIPAA. Or maybe that’s old news