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.

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Nursing Homes Nurses Compliance Medicare 52

Healthcare IT Today

JULY 19, 2022

Additionally, with this certification, Canvas customers are now eligible for value-based payment models in Medicare and Medicaid programs, as well as many commercial value-based programs. . Founded in 2015, Canvas is reimagining the EMR for the future of healthcare. About Canvas Medical.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIT Consultant

MAY 24, 2023

With an anticipated dramatic rise of Americans diagnosed with AD approaching, broad changes to Medicare are needed. While Medicare and other sources of financial assistance may cover some of these costs, they won’t cover it all, leaving individuals with AD or other dementias and their families with high out-of-pocket costs.

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Medicare Medicare FDA Governance 97

Healthcare IT Today

JULY 10, 2023

Company Adds Two Board Members and a Senior Executive to Lead its Medicare Advantage Business Aledade , the largest network of independent primary care practices in the country, today announced the closing of a $260 million Series F funding round to enhance and acquire services and technology to support its practices.

Medicare 52

Medicare Medicare Health Outcomes 52

MedTrainer

MARCH 28, 2024

Healthcare Compliance Complexities The first healthcare compliance programs began in the early 20th century as a response to concerns about the quality of care provided by medical practitioners. Cons: May not be familiar with mandated reporting or may be apprehensive about reporting due to fear of retaliation. See MedTrainer in action.

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Compliance Compliance Officers Licensing Regulatory Compliance 52

Healthcare IT Today

AUGUST 29, 2022

Programs such as the Medicare Shared Savings Program (MSSP) are mandating high-revenue healthcare organizations, often hospitals and health systems, progress towards downside risk in increasingly shorter timelines. About CareHarmony. We’re excited to partner with CareHarmony as they continue to transform care coordination.”.

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Medicare Medicare Hospitals 59

HIPAA Journal

OCTOBER 21, 2022

A common misconception about HIPAA is that all healthcare data is subject to its protection. Advocates of NPIs are hoping that the introduction of Medicare Beneficiary Numbers (which went into effect in January 2020) will demonstrate to Congress that the benefits of NPIs far outweigh the costs. #4. billion and $11.5

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HIPAA Compliance Medicare Medicare 95

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Administrator, Centers for Medicare & Medicaid Services. 2018 Medicare Fee-For-Service improper payment rate is lowest since 2010 Significant progress in saving $4.59B in estimated improper payments for the Medicare Fee-For-Service program.

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Medicare Medicare Overpayments Overpayment 20

HIT Consultant

OCTOBER 6, 2021

For this woman, the issue is not simply a matter of not having received what, in her view, was adequate training, but also the anxiety she feels about potentially causing harm to her husband each time she carries out a skilled level of care that she believes would be better left to a qualified healthcare professional.

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COVID-19 Doctors Health Outcomes Licensing 98

HIT Consultant

APRIL 12, 2022

Second, the number of unpaid family caregivers in the United States increased by nearly 10 million people between 2015 and 2020 to 54 million. Through interpersonal communication and technology, DUOS identifies and addresses the individual needs of older adults by leveraging Medicare benefits, trusted partners, and local service providers.

Medicare 52

Medicare Medicare COVID-19 Health Insurance 52

Healthcare IT Today

DECEMBER 17, 2023

Though this is a significant increase from 2012, numbers haven’t budged much since 2015. Studies About 70% of hospitals face hidden challenges to business continuity , such as poor data integrity or network disruptions, according to a report from Veriti.

Hospitals 91

Hospitals Nurses Compliance Regulatory Compliance 91

HIT Consultant

APRIL 20, 2022

Since the passage of the Medicare Improvements for Patients & Providers Act in 2008, the U.S. Hospitals report the data to the Centers for Medicare & Medicaid Services (CMS), which uses that data to create the Overall Hospital Quality Star rating for each hospital. Tom Zaubler, MD, Chief Medical Officer of NeuroFlow.

Medicare 98

Medicare Medicare Telemedicine Medicaid 98

Provider Trust

JULY 26, 2023

The data included in provider directories is comprised of information about individual providers, groups of providers, or institutions, including what services they provide, the health plans and networks they participate in, and contact information and location details. Unfortunately, provider directories are often riddled with inaccuracies.

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Medicaid Medicaid Compliance Medicare 52

Hall Render

AUGUST 1, 2022

The OPPS Proposed Rule also discusses quality-reporting requirements for REHs, an expedited Medicare enrollment process and REH-specific Stark Law updates. Hospitals may only convert to REHs if they were a CAH or rural hospital with not more than 50 beds participating in Medicare as of December 27, 2020. REH Enrollment Process.

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

MedTrainer

MARCH 3, 2021

The Physician Quality Reporting System (PQRS) was first introduced over a decade ago by the Centers for Medicare and Medicaid Services (CMS) as a quality reporting program. In 2015, the reporting program shifted from a voluntary program to a mandatory one in which penalties would be assessed for failure to participate.

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Medicare Medicare Medicaid Medicaid 40

HIT Consultant

DECEMBER 30, 2021

Each day there are fresh headlines about new waves of infections popping up around the world. A few years ago, Pew Research projected that 10,000 men and women would be retiring each day which would double Medicare and Medicaid costs by 2020. About Greg Kefer. Greg Kefer, CMO of Lifelink Systems.

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COVID-19 Doctors Nurses Medicare 97

AIHC

NOVEMBER 6, 2023

What about Artificial Intelligence? Consequences can include public disclosure of the provider’s violation, administrative reprimands, and termination of Medicare and Medicaid billing privileges by being listed on the Office of Inspector General (OIG) Exclusions List. In 2020, the U.S. OCR can impose civil money penalties up to $1.5

HIPAA 59

HIPAA Compliance Governance Health Insurance 59

AIHC

NOVEMBER 6, 2023

What about Artificial Intelligence? Consequences can include public disclosure of the provider’s violation, administrative reprimands, and termination of Medicare and Medicaid billing privileges by being listed on the Office of Inspector General (OIG) Exclusions List. In 2020, the U.S. OCR can impose civil money penalties up to $1.5

HIPAA 52

HIPAA Compliance Governance Health Insurance 52

Verisys

NOVEMBER 14, 2023

With proven credentialing software, you never have to worry about scalability if you’re rapidly hiring and credentialing more healthcare providers. Many healthcare organizations find themselves in a merger and suddenly serve more providers than their staff can handle. This could create a huge liability issue.

Licensing 52

Licensing Medicaid Medicaid Governance 52

Healthcare Law Blog

NOVEMBER 21, 2022

22-19 (the “Advisory Opinion”), which declared that a charitable organization funded by manufacturers would violate the AKS if it offered certain cost-sharing subsidies under Medicare Part D (“Part D”), even if the organization was independently run and patients had equal access to discounts for 90% of drugs on the market. 2, 2015). [10]

Medicare 52

Medicare Medicare Governance Medicaid 52

Healthcare IT Today

APRIL 10, 2023

Uncle Roy spent years on dialysis and passed away after having a stroke in 2015. about 1 in 5 prescriptions are never filled, and of those filled, approximately 50% are taken incorrectly (timing, dosage, frequency, duration). Medicare Advantage, Medicaid, ACA/Exchange) that share in our mission. In the U.S.,

Health Outcomes 89

Health Outcomes Hospitals ACA Doctors 89

Healthcare Blog

AUGUST 23, 2023

Watching posts or comments about experiences at your organization can help identify areas that need improvement. Resources Available to Help Healthcare Organizations Promote Ethical Behavior The Centers for Medicare and Medicaid Services has many policies, procedures, and legislation on ethical standards in healthcare.

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Compliance Nurses Regulatory Compliance Medicaid 56

HIPAA Journal

JUNE 26, 2023

The Centers for Medicare and Medicaid Services (CMS) also temporarily expanded telehealth options for all Medicare and Medicaid recipients. To support healthcare providers, OCR announced a Notice of Enforcement Discretion covering telehealth remote communications for the duration of the public health emergency.

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HIPAA COVID-19 COVID-19 Vaccine Public Health 68

HIT Consultant

FEBRUARY 7, 2022

Medicare and Medicaid have an obligation to taxpayers who are paying into the system to help as many people as possible. In a real-world example, a case manager logs onto work on a Monday morning and receives an email with details about their patient, John Doe. About Dr. John Sargent. We can’t do it alone.

Doctors 98

Doctors Health Outcomes COVID-19 Health Insurance 98

Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. Additionally, check out this HHS-OIG 2016 report, Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure , which revealed “vulnerabilities that could allow potentially fraudulent providers to enroll in the Medicare program.”. Explore Our Solution.

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Compliance Due Diligence Medicaid Medicaid 52

Kaiser Health News

JANUARY 19, 2022

A spokesperson for the Centers for Medicare & Medicaid Services said in an email that the agency is not seeing a pervasive problem, but he declined to provide data on how often such cases occur or how the agents or brokers get the personal information needed to enroll unsuspecting people.

ACA 72

ACA Health Insurance Licensing Governance 72

CMS.gov

AUGUST 23, 2018

Note: 2014 data was as of 5/27/14, 2015 was as of 11/03/14, 2016 was as of 10/29/15, 2017 was as of 11/05/16, 2018 was as of 11/07/17. Note: 2015 enrollment was as of 5/6/15, 2016 enrollment was as of 8/22/16, 2017 enrollment is as of 5/31/17 , and 2018 enrollment is as of 12/23/17. Percentage [3].

Health Insurance 42

Health Insurance Medicare Medicare 42

HIPAA Journal

DECEMBER 31, 2022

The evidence that there may be a misunderstanding about what a HIPAA violation is comes from the Department of Health and Human Services (HHS) Enforcement Highlights web page. The web page is regularly updated with statistics relating to complaints about HIPAA violations, compliance reviews, and enforcement action.

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HIPAA Due Diligence Compliance Fraud 132

Verisys

JANUARY 18, 2022

All state-level Federal Healthcare Entitlement Program (FHEP) sources including state Medicaid exclusions, state Contractor Disqualification/Debarment lists, HEAT Task Force News, state Attorney General News, Federal District – Attorney General News, and Medicare/Medicaid opt-out lists. ISO 9001:2015 (quality management).

Licensing 52

Licensing Medicaid Medicaid Governance 52

Provider Trust

JULY 26, 2022

This resulted in the practice submitting at least $147,000 in fraudulent claims for reimbursement to Medicare and numerous private insurance companies. Learn more about a comprehensive and automated license and exclusion monitoring solution. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud.

Licensing 52

Licensing Fraud Compliance Nurses 52

HIPAA Journal

JANUARY 31, 2024

Aside from 2015, the number of reported security breaches in healthcare has increased every year although the rate of increase is slowing and 2024 could see the healthcare industry start to turn the corner. It is not just the increasing number of data breaches that is a cause of concern it is the scale of these data breaches.

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Ransomware HIPAA Hospitals Compliance 118

Hall Render

JUNE 22, 2022

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CMS recognizes a need to smooth these transitions and help to ensure stability in Medicare payments.

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COVID-19 Payment Systems Medicare Medicare 40

The Digital Health Corner

JUNE 14, 2017

According to most recent statistics from the Office of the National Coordinator, use of EHRs has increased from 20% in 2004 to 87% in 2015. I’d like to discuss what I believe are five areas of significant opportunity for quality technologies. EHRs were designed as documentation centers for billing and regulatory purposes.

Patient Satisfaction 87

Patient Satisfaction Hospitals FDA Governance 87

HIT Consultant

NOVEMBER 29, 2022

Beyond the fact that DotCom Therapy has been successfully delivering services since 2015, a review of two dozen studies in 2019 found that phone and video therapies were equally effective at treating conditions like anxiety, depression, and post-traumatic stress disorder as in-person therapy. About Serrah Linares.

Medicaid 98

Medicaid Medicaid Telemedicine Governance 98

Healthcare IT Today

OCTOBER 19, 2022

Beyond the fact that DotCom Therapy has been successfully delivering services since 2015, a review of two dozen studies in 2019 found that phone and video therapies were equally effective at treating conditions like anxiety, depression, and post-traumatic stress disorder as in-person therapy. About Serrah Linares.

Medicaid 89

Medicaid Medicaid Telemedicine COVID-19 89

Healthcare IT News - Telehealth

JANUARY 3, 2023

Louis, Missouri, embarked on amplifying a new digital-first frontier in 2015: A new virtual care model of remote patient monitoring for patients living with complex conditions. Sadly, after attempting to navigate this messy world of chronic disease alone, many patients stop trying to figure out what symptoms to be most worried about.

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Hospitals Patient Satisfaction Nurses Telemedicine 184

Healthcare IT News - Telehealth

MARCH 18, 2022

Healthcare IT News sat down with this digital health investor to talk about digital health investment trends during the pandemic and where he sees funding trending in 2022 and beyond. Norden is particularly passionate about funding companies focused on the Medicaid population – a traditionally tricky and often ignored area.

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Medicaid Medicaid COVID-19 Telemedicine 198