Med-Net Compliance

JULY 26, 2022

In connection with the enforcement action, the department seized over $8 million in cash, luxury vehicles, and other fraud proceeds. Additionally, the Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), announced that it took administrative actions against 52 providers involved in similar schemes.

Fraud 59

Fraud Telemedicine Medicare Medicare 59

Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors? Department of Justice (DOJ), the U.S.

Fraud 52

Fraud US Department of Health and Human Services Medicaid Medicaid 52

American Medical Compliance

MARCH 15, 2024

Among the various areas of compliance, Fraud, Waste, and Abuse (FWA) compliance stands out as a critical pillar. The Department of Justice recently revealed charges against 78 individuals involved in healthcare fraud schemes. However, they encounter numerous challenges in achieving this goal.

Compliance 105

Compliance Fraud HIPAA Health Insurance 105

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. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. With Medicaid, the challenges are equally formidable.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Provider Trust

MARCH 16, 2022

Exclusions are administrative actions that are placed upon an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or by one of the many agencies associated with SAM.gov. Additionally, there are varying, disparate State Medicaid exclusions sources that require periodic screening.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare IT News - Telehealth

JUNE 28, 2021

" VanLandingham, who is senior counselor, Medicaid Policy/Acting Health IT at the agency, will be presenting at HIMSS21 this summer, HHS-OIG colleague, Assistant Inspector General for Legal Affairs Lisa Re. " VanLandingham explained that the healthcare fraud space gets "tens of thousands of complaints."

US Department of Health and Human Services 195

US Department of Health and Human Services Fraud Compliance Medicaid 195

The Health Law Firm

SEPTEMBER 24, 2013

Leider with The Health Law Firm will be giving a presentation on Thursday, September 26, 2013, to the members of the Medical Office Resources of Florida (MOROF) and attending health care providers. This presentation is called, “Medicare and Medicaid Audits: Ready or Not, Here They Come.” Brown and Lance O.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Compliancy Group

FEBRUARY 28, 2024

Within the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing and administering various healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These audits should occur once per year.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

Provider Trust

AUGUST 9, 2023

Grimm, the OIG continues its tireless efforts to uncover instances of fraud, waste, and abuse within HHS programs. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

Provider Trust

SEPTEMBER 12, 2022

In 2006, New York’s Office of the Medicaid Inspector General (OMIG) was established as an independent office within New York State’s Department of Health to combat fraud and abuse in New York State’s Medicaid program. What is New York's OMIG List of Restricted and Excluded Providers?

Medicaid 52

Medicaid Medicaid Fraud Licensing 52

MedTrainer

SEPTEMBER 20, 2023

If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations. There are several accrediting organizations that require facilities to meet or exceed Medicaid and Medicare guidelines. Accreditation.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

Provider Trust

JANUARY 18, 2023

In October 2022, the South Carolina Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old South Carolina woman named Alyssa Beth Steele for working as a registered nurse despite not having a license. Pursuant to federal regulations, the SCMFCU is authorized to investigate and prosecute any acts of Medicaid provider fraud.

Nurses 52

Nurses Licensing Fraud Medicaid 52

Bill of Health

FEBRUARY 10, 2023

That is why the ACA’s Medicaid expansion doesn’t exist in 11 states , why the penalties for failing to have insurance under the “individual mandate” has been set to $0.00. Or an extension of the doctrine of public fraud? Witness the success of environmental policy litigation in the ’70s. Maybe some form of public nuisance litigation?

Public Health 261

Public Health Health Care Reform ACA COVID-19 261

HIT Consultant

MAY 2, 2023

Modern NEMT solutions streamline the ride booking and scheduling process, introduce new modalities, improve the overall experience for patients, and decrease fraud, waste and abuse (FWA). As Medicare Advantage and Medicaid plans continue to grow, NEMT partners will play an increasingly important role in scaling transportation benefits.

Medicaid 96

Medicaid Medicaid Medicare Medicare 96

HIPAA Journal

OCTOBER 10, 2022

According to the breach notice, a presentation was emailed to the DHS Children’s Long-Term Support Council in April 2021 that contained protected health information. Steps were also taken to recover all distributed copies of the presentation.

Medicaid 55

Medicaid Medicaid Governance Fraud 55

CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Between 2013 and 2016, Federal spending on Medicaid grew by over $100 billion.

Medicaid 40

Medicaid Medicaid Fraud Health Outcomes 40

Healthcare IT News - Telehealth

JANUARY 26, 2022

Healthcare IT News interviewed Griffin to take a closer look at what he will be presenting at the HIMSS22 conference. The evergreen concern about virtual care is that of fraud, waste and abuse and how to balance it with the demonstrated value of extended medical services to patients who are either geographically or economically underserved.

Fraud 148

Fraud Telemedicine COVID-19 Licensing 148

Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. The risk categories are described as follows: Highest Risk—Exclusion: Parties that the OIG determines present the highest risk of fraud will be excluded from Federal healthcare programs to protect those programs and their beneficiaries.

Fraud 59

Fraud Compliance Medicare Medicare 59

Verisys

JANUARY 6, 2022

Payments from Medicare, Medicaid, TRICARE, CHIP, and other federal programs are a significant source of funds for nearly every healthcare organization and provider. The OIG through the Social Security Act has the power to bar individuals and entities from receiving federal payments as the result of intentional fraud or abuse.

US Department of Health and Human Services 52

US Department of Health and Human Services Fraud Medicaid Medicaid 52

AIHC

APRIL 5, 2022

Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse. Prior to appealing a Medicare, Medicaid, TriCare or other Federal Program claim, you should verify that your organization is compliant in this area ( click here ).

Fraud 52

Fraud Compliance Medicare Medicare 52

McGuire Wood

OCTOBER 2, 2023

If, however, an institution is concerned that its past practices have violated one of the fraud and abuse laws mentioned above, it may consider three avenues for a self-disclosure. Finally, management should focus discussions with acquisition targets on the asset itself and not on potential referrals to other entities in the platform.

Fraud 52

Fraud Governance Compliance Medicare 52

Medisys Compliance

OCTOBER 20, 2023

Insurance Reimbursement: Emergency medical services are typically covered by various insurance plans, including public programs like Medicare and Medicaid, as well as private insurance. Reimbursement is based on contract agreements and fee schedules.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medical Billing Services Compliance 59

Provider Trust

JULY 8, 2022

In this quick guide, we’ll explore the importance of including NPDB monitoring in your routine license and exclusion monitoring to protect your organization and the patients you serve from fraud, waste, and abuse. Its mission is to enhance healthcare quality, defend the public, and decrease healthcare fraud and misuse in the U.S.

Licensing 52

Licensing Malpractice Fraud Compliance 52

Healthcare Law Blog

MAY 11, 2023

Review of the Proposed Arrangement Under Federal AKS At a high level, the OIG concluded that the Arrangement presents a minimal risk of fraud and abuse under the AKS. Finally, the OIG noted that the listed safeguards set forth by the Companies reduce the risk of fraud and abuse.

Medicare 52

Medicare Medicare Fraud Compliance 52

AIHC

NOVEMBER 29, 2023

As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar. As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Innovaare Compliance

AUGUST 31, 2022

Medicare Advantage Organizations (MAOs) are private health plans that contract with the Centers for Medicare & Medicaid Services (CMS) to provide a menu of health care services similar to those offered under Original Medicare. 1 They pay for the services with monthly fixed payments (capitation) from CMS. or Contact Us .

Medicare 52

Medicare Medicare Compliance Officers Fraud 52

Health Law Advisor

APRIL 10, 2023

This interpretation provided to be difficult to apply in real world situations because while we all might think of Amazon and WalMart as big-box stores, it was not clear what other stores might also fall into this category and present a compliance risk. OIG Advisory Opinion (AO) 23-03 On March 29, 2023, the OIG posted AO 23-03 to its website.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

AIHC

NOVEMBER 29, 2023

As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar. As more and more potential and real fraud, waste, and abuse was uncovered in the FFS arena, it was also discovered that patient outcomes were less than stellar.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

Fraud 52

Fraud Medicaid Medicaid Nurses 52

Healthcare Compliance Blog

FEBRUARY 8, 2022

The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta. From 2015 through 2019, the pharmaceutical company that manufactures Nuedexta paid the Alabama psychiatrist more than $400,000 to make speeches about Nuedexta.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

Hall Render

NOVEMBER 15, 2023

Billing for Advanced Practice Professionals (“APPs”) has been a challenging area for providers and practitioners because of different and changing Medicare, Medicaid and state law requirements. The Arrangement contains safeguards that lower the risk of fraud and abuse under the federal AKS.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Hall Render

MAY 9, 2022

In connection with the COVID-19 public health emergency (the “PHE”), and the expanded coverage of telehealth services by Medicare and state Medicaid programs in response thereto, the FQHC received grant funding from the Federal Communications Commission and a local charity to purchase approximately 3,000 smartphones.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Med Law Blog

MAY 1, 2023

As you might expect from a federal investigation, conducted by politicians with media present, the tone of the meeting was more hostile rather than supportive. In March 2023, the House Ways and Means Committee hosted an investigative hearing on “private equity’s expanded role in the US healthcare system”.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52

Healthcare IT News - Telehealth

SEPTEMBER 9, 2020

During the public health emergency, the Centers for Medicare and Medicaid Services temporarily expanded that coverage – for example, allowing clinicians to provide services to patients in their homes and in non-rural settings. Presenters also zeroed in on audio-only services. And last but not least, large-scale fraud.

Medicare 133

Medicare Medicare Public Health HIPAA 133

AIHC

SEPTEMBER 5, 2023

Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs. This includes understanding various fraud and abuse laws.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Health Care Law Brief

JUNE 2, 2022

Variety of Risks Present in Telehealth Arrangements. The severity and type of risk present in a telehealth business will vary—by jurisdiction, by provider type, by service offering, and by payor mix. Does the state apply different standards, for example, to Medicaid encounters? Provider Licenses.

Public Health 52

Public Health Compliance COVID-19 Licensing 52