Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. As a healthcare provider, being familiar with healthcare fraud and abuse laws is important. government or a government contractor.

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Fraud Medicaid Medicaid Medicare 52

American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. To become certified, please visit us at: American Medical Compliance (AMC).

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Fraud Medicare Medicare Compliance 52

Provider Trust

MARCH 13, 2023

Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail. Donna Thiel, Chief Compliance Officer at ProviderTrust, said, “It’s an opportunity to promote partnership between HR and compliance.

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Fraud US Department of Health and Human Services Licensing Compliance Officers 52

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

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Fraud Medicaid Medicaid Nursing Homes 59

American Medical Compliance

FEBRUARY 15, 2023

The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Fraud schemes range from solo ventures to widespread activities of an institution or group.

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Fraud Medicare Medicare Compliance 52

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Such an ongoing auditing system is crucial to a healthcare organization’s compliance program.

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Compliancy Group

MARCH 21, 2024

Office of Inspector General (OIG) of the Department of Health and Human Services (DHHS) oversees regulations covering federal programs offering benefits to healthcare organizations. All these tasks can seem daunting to even the most organized compliance officers. For example, how do they make the training engaging and memorable?

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Compliance US Department of Health and Human Services Compliance Officers Fraud 52

Compliancy Group

MARCH 22, 2024

As a compliance officer or critical decision-maker, you can help your healthcare organization avoid exclusion from this valuable program by creating a comprehensive compliance program and using software to streamline your compliance processes. Over 65 million people in the U.S.

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Medicare Medicare Compliance Compliance Officers 52

HealthStream

AUGUST 26, 2019

Compliance officers must work to prevent criminal healthcare fraud cases, especially given the expansion of DOJ focus areas for investigating possible fraudulent action.

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HIPAA Journal

MARCH 30, 2023

While the seven elements of a compliance program apply to all industries, they originated in the healthcare industry in the 1990s. This was in response to the growing level of healthcare fraud and abuse and an alleged “compliance disconnect” at the executive level in many hospitals and health systems.

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MedTrainer

JANUARY 30, 2024

Healthcare compliance is a critical part of any organization’s business model. The professionals who manage compliance are the front lines of preventing medical errors, deterring fraud, and staying in good standing with federal payers like the Centers for Medicare and Medicaid Services (CMS).

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Compliance Compliance Officers Fraud Medicaid 52

Compliancy Group

FEBRUARY 26, 2024

A comprehensive hospital compliance work plan is pivotal for achieving these objectives. Hospital compliance officers, c-suite executives, and other decision-makers must constantly stay abreast of the latest developments in healthcare compliance.

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Compliance US Department of Health and Human Services Hospitals Compliance Officers 52

Healthcare Law Blog

NOVEMBER 9, 2023

Thereafter, OIG said it planned to update existing industry-specific compliance program guidance (ICPG), which would include tailoring each to address fraud and abuse risk areas specific to a particular industry and describing the compliance measures that industry could take to reduce these risks [2].

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Compliance Compliance Officers Fraud Medicare 52

MedTrainer

JANUARY 31, 2024

Certified Professional Compliance Officer (CPCO): The CPCO certification is offered by the American Academy of Professional Coders and is tailored to professionals who manage and lead compliance programs. Certified Medical Compliance Officer (CMCO): The CMCO certification is offered by the Practice Management Institute.

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Compliance Compliance Officers Fraud Regulatory Compliance 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Given the severity of penalties associated with FWA, compliance professionals’ knowledge and skills will be crucial to ensuring that their organizations avoid penalties and provide compliant patient care.

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US Department of Health and Human Services Compliance Officers Compliance Fraud 52

MedTrainer

JANUARY 10, 2024

Review Recent Compliance Changes There is a major shift in compliance priorities toward addressing health inequities and improving access to quality healthcare services. The OIG is making major investments to systematically detect and prosecute fraud. We all should be a LOT more prepared!

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Compliance Fraud HIPAA Compliance Officers 94

YouCompli

MAY 11, 2022

The doctor will be sentenced in July for multiple counts of healthcare fraud. Compliance officers should watch for: Follow the money. If a practice is billing millions of dollars for allergies services, that code or set of codes is likely to stand out as an outlier to compliance programs monitoring all their billing data.

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Compliance Officers Fraud Compliance Medicare 52

Health Law RX

JANUARY 30, 2024

By maintaining a robust compliance program, healthcare companies are better able to identify potential red flags early and to prevent violations of fraud and abuse laws.

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Compliance Due Diligence Fraud Governance 52

YouCompli

DECEMBER 19, 2023

Compliance Officer (page 38) : The OIG clarifies that compliance officers “have sufficient stature within the entity to interact as an equal of other senior leaders of the entity.” Effective communication and collaboration between compliance and legal is the key to a successful outcome.

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Compliance Compliance Officers Medicaid Medicaid 52

MedTrainer

JANUARY 26, 2024

Compliance Officers: Healthcare compliance officers , responsible for overseeing and enforcing compliance within healthcare organizations, often hold healthcare regulatory compliance certificates. These certificates validate their expertise in monitoring and ensuring compliance within their institutions.

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Regulatory Compliance Compliance Compliance Officers HIPAA 52

YouCompli

NOVEMBER 29, 2023

“As previous OIG compliance guidance(s) are retired to ‘archival’ status, we all should recognize that the original guidance may have been the most important document ever written for healthcare compliance professionals.” — Roy Snell In 1998, the Office of Inspector General (OIG) issued its first General Compliance Program Guidance (GCPG).

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Compliance Compliance Officers Medicaid Medicaid 52

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

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Fraud Compliance Officers Compliance Medicare 52

Compliancy Group

AUGUST 31, 2023

Healthcare compliance laws play a vital role in safeguarding patients’ rights, preventing fraud and abuse, and maintaining the integrity of healthcare systems. Let’s delve into the importance of healthcare compliance laws and regulations, their impact on providers and organizations, and the guidelines governing their implementation.

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Compliance Compliance Officers Fraud Compliance Framework 52

Compliancy Group

JULY 12, 2023

Designating a compliance officer and compliance committee. Assigning a Designated Compliance Officer This person oversees the organization’s adherence to healthcare compliance standards. This individual or group plays a crucial role in implementing the compliance program effectively.

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Compliance Compliance Officers Fraud HIPAA 52

Compliancy Group

FEBRUARY 7, 2024

CMS UPIC audits are designed to identify and prevent fraud, waste, and abuse within Medicare and Medicaid, ensuring that federal funds are used appropriately and that the services billed for are actually provided and are medically necessary. Given their significant impact, healthcare organizations must take UPIC audits seriously.

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Fraud Compliance Medicare Medicare 52

Hall Render

NOVEMBER 10, 2023

These ICPGs will address fraud and abuse risk areas for each specific industry subsector and compliance measures that can be taken to reduce fraud and abuse risks. OIG plans to periodically update these ICPGs to address newly identified risk areas and compliance measures and to ensure timely and meaningful guidance.

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Compliance Compliance Officers Fraud Governance 40

MedTrainer

OCTOBER 23, 2023

Office of Inspector General (OIG): Prevents fraud, waste, and abuse within the department’s vast array of Department of Health and Human Services (HHS) initiatives. Technology is sure to play a critical role in the future of healthcare compliance. Learn more about how MedTrainer can streamline your compliance.

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Compliance Compliance Officers Fraud Governance 52

MedTrainer

JANUARY 31, 2024

Who started the first healthcare compliance program? It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. However, it wasn’t until the mid-20th century that healthcare compliance regulations and programs began. What is Healthcare Compliance?

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Compliance Fraud Governance ACA 52

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. But what exactly is considered fraud, waste, and abuse? These complaints can trigger an audit. Data Analysis and Trends.

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MedTrainer

NOVEMBER 14, 2023

Financial Risks: They encompass losses from billing errors, fraud, and abuse claims, or failed investments related to healthcare provisions. By ensuring policies comply with applicable laws, regulations, and standards, you are providing operational guidance and setting standards for compliance.

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Compliance Compliance Officers Fraud Malpractice 52

C&M Health Law

DECEMBER 18, 2023

Compliance policies should be developed under the direction and supervision of the compliance officer and compliance committee and should address the implementation and operation of an entity’s compliance program and processes. OIG’s updated take on the seven elements is briefly summarized below. (1)

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Compliance Compliance Officers Governance Overpayments 52

Health Law Advisor

AUGUST 25, 2023

Lines of communication regarding compliance issues must satisfy specified criteria, including a method for anonymous reporting for potential fraud, waste, and abuse issues directly to the organization’s Compliance Officer. New Self-Disclosure Program rules (amendments to N.Y.

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Compliance Overpayments Overpayment Compliance Officers 52

Healthcare Law Blog

FEBRUARY 9, 2024

million to resolve a lawsuit filed by the system’s former Chief Compliance Officer, Ronald Sherman. ChristianaCare denied these allegations and claimed that Sherman was granted the necessary authority in full compliance with the CIA. Delaware-based ChristianaCare Health System (ChristianaCare) [1] recently agreed to pay $47.1

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Hospitals Compliance Officers Compliance Overpayments 52

Healthcare Compliance Blog

FEBRUARY 15, 2022

billion in settlements and judgments have been recovered by the Department of Justice Department (DOJ) related to civil cases involving fraud and false claims in fiscal year 2021. The government paid $237 million in fiscal year 2021 to whistleblowers who exposed fraud and false claims. More than $5.6

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Fraud Governance Compliance Medicare 59

MedTrainer

FEBRUARY 1, 2024

A “red flag” in healthcare compliance refers to a warning sign or indicator that suggests a potential issue or violation of healthcare laws, regulations, or policies. These red flags are used to identify situations or activities that may raise concerns about fraud, waste, abuse, or non-compliance with healthcare regulations.

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Compliance Compliance Officers Fraud HIPAA 52

MedTrainer

SEPTEMBER 8, 2023

Certified Professional Compliance Officer (CPCO): The CPCO certification is offered by the American Academy of Professional Coders and is tailored to professionals who manage and lead compliance programs. Certified Medical Compliance Officer (CMCO): The CMCO certification is offered by the Practice Management Institute.

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Compliance Compliance Officers HIPAA Regulatory Compliance 52

YouCompli

AUGUST 2, 2022

Different kinds of fraud and abuse have sprung up in relation to vaccination cards. Considerations for healthcare compliance officers. Compliance officers should make sure their organizations are delivering on their promises. Read more about how enforcement officials like to work with compliance professionals.)

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