Healthcare Compliance Blog

APRIL 27, 2022

A robust compliance and ethics program can help identify false claims therefore reducing fraud, waste, and abuse of government funds. A robust compliance and ethics program can help identify false claims therefore reducing fraud, waste, and abuse of government funds.

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Medicaid Medicaid Compliance Governance 59

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. Diagnosis codes are an important compliance aspect of reporting medical necessity on the claim. Can the investigators “get it wrong”? They can, sometimes!

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Fraud Medicare Medicare Compliance 52

McGuire Wood

OCTOBER 2, 2023

According to the DOJ press release, from January 2013 to July 2018, Oliver Street, doing business as U.S. Further, if ancillary services are involved, there should be analysis to confirm compliance with the Stark Law and the AKS. This settlement includes more than $5.928 million in restitution, essentially a payment of 1.49

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Fraud Governance Compliance Medicare 52

Total HIPAA

SEPTEMBER 11, 2019

This post aims to answer all of your HIPAA compliance questions. If you’re just learning about HIPAA compliance, or beginning the process of becoming HIPAA compliant, this article will guide you through the initial steps you must take to adhere to the law. What is HIPAA Compliance? Protected Health Information (PHI).

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HIPAA Compliance US Department of Health and Human Services Health Insurance 52

Compliancy Group

JUNE 15, 2023

The Details OCR initiated its investigation into Yakima in May 2018 after receiving a breach notification report that 23 security guards used their login credentials to access patient electronic protected health information (ePHI). HIPAA Compliance Software Learn How Simple Compliance Can Be Get Compliant Today! ×

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HIPAA Compliance Fraud Hospitals 52

Healthcare Compliance Blog

MAY 11, 2022

The South Carolina Attorney General announced that his office’s Medicaid Fraud Control Unit (SCMFCU) had arrested a 57-year-old woman on two counts of Exploitation of a Vulnerable Adult and two counts of Breach of Trust with Fraudulent Intent, value of $10,000 or more.

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Fraud Nursing Homes Medicaid Medicaid 59

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Fri, 11/16/2018 - 18:46. Fraud, waste, & abuse. 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. Seema Verma.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Healthcare Compliance Blog

APRIL 6, 2022

Evidence revealed that the nurse failed to administer a total of eight required neurological checks to the patient after he had an unwitnessed fall at the facility on the night of April 12, 2018. on the morning of April 13, 2018, as a result of a subdural hematoma. He was discovered deceased just after 7:00 a.m.

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Nurses Nursing Homes Fraud Licensing 59

Healthcare Compliance Blog

MARCH 31, 2022

The DOJ, in coordination with the Medicaid Fraud Control Unit of the Office of the New York State Attorney General, began an investigation after whistleblowers alleged that certain LHCSAs had knowingly defrauded the federal government and New York State by underpaying home health aides in violation of New York’s Wage Parity Act.

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Medicaid Medicaid Governance Fraud 59

Health Law RX

JUNE 27, 2023

The First Circuit placed an onus on the relator to avoid dismissal by showing that the Government’s motion was “transgress[ing] constitutional limitations” or “perpetrating a fraud on the court” ( Borzilleri v. Bayer Healthcare Pharms., 4th 32, 42 (1st Cir. Cimznhca, LLC v. UCB, Inc. , 3d 835, 850-51 (7th Cir.

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Governance Fraud Compliance 52

HIT Consultant

NOVEMBER 24, 2022

– Delivery model : Whether to ship OTC products to a hearing clinic where the consumer can receive professional diagnosis, fitting and support, or ship directly to the consumer’s home thereby providing convenience but no professional support (and increased fraud risk), or offer both options? 4 And compliance decrease over time. .

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FDA Public Health Medicare Medicare 98

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

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Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

Provider Trust

OCTOBER 29, 2021

There are so many things pulling compliance and HR teams in every direction, I help solve the problem of “how do we do this more efficiently?”. My favorite memory at ProviderTrust was the holiday celebration in 2018. In the simplest terms, I help solve problems! How long have you worked at ProviderTrust?

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Fraud Nurses Compliance 97

Health Care Law Brief

APRIL 12, 2023

405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. MA plans will be required to have a Utilization Management Committee that conducts annual reviews of policies to ensure compliance with the foregoing. Final Rule at p. 3d 173, 191 (D.D.C. rather than a ‘limited duty to inquire.”

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Total HIPAA

FEBRUARY 25, 2020

That same year, the number of organizations that contacted the security firm Emsisoft after ransomware attacks grew to 205,280 — a 41 percent increase from 2018. The agency received 1,493 reports of attacks in 2018, although the number of total incidents is probably higher.². How to Protect Yourself from Ransomware.

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Ransomware HIPAA Compliance Fraud 52

Florida Health Care Law Firm

FEBRUARY 22, 2022

He has also had assets forfeited since these assets were acquired with money from his ill-gotten fraud scheme. From January 2018 to 2019, this scheme of greed resulted in approximately $12 million in payment to Truglia and his co-conspirators. In total, Mr. Truglia and his co-conspirators collected approximately $18.5

Medicare 52

Medicare Medicare Telemedicine Fraud 52

Florida Health Care Law Firm

DECEMBER 9, 2021

Some states have enacted balance billing protections, for example, in 2018 Florida passed “Coverage requirements for services provided by non-participating providers; payment collection limitations”. The teaching status, case mix and scope of services of the facility where service was delivered.

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Medical Billing Medicare Medicare Compliance 40

CMS.gov

JUNE 20, 2018

Wed, 06/20/2018 - 16:17. Fraud, waste, & abuse. One of the top areas of burden identified in the over 2,600 comments received was compliance with the physician self-referral law (often called the “Stark Law”) and its accompanying regulations. Working Together for Value. lisa.sokol@cms…. Seema Verma. Administrator, CMS.

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Medicare Medicare Fraud Medicaid 30

Compliancy Group

AUGUST 23, 2023

September of 2020 marked the month when Cronin, burdened by guilt, reluctantly admitted to a single count of conspiring to orchestrate health care fraud and another count of brazenly committing such deceitful acts. Prosecutors Evan Panich and Chris Looney from the Health Care Fraud Unit, alongside Special Assistant U.S.

Fraud 52

Fraud Medicaid Medicaid Governance 52

HIPAA Journal

JANUARY 24, 2023

The theft of protected health information places patients and health plan members at risk of identity theft and fraud, but by far the biggest concern is the threat to patient safety. In addition to the slight reduction in reported data breaches, there was also a drop in the number of breached records, which fell by 13.15% from 54.09

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HIPAA Ransomware Hospitals Fraud 111

Hall Render

JULY 12, 2023

CMS has seen hundreds of hospice ownership changes since 2018, for which CMS may not know whether the facility under its new ownership and leadership is compliant with the hospice regulatory requirements for participation. CMS believes that additional provider enrollment measures are necessary to help address these concerns.

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Medicare Medicare Nursing Homes Fraud 40

HIPAA Journal

JULY 24, 2023

Healthcare providers participating in federal healthcare programs are advised to regularly check the HHS OIG Exclusions List to avoid penalties for non-compliance with §1128 of the Social Security Act. This article answers the following: What is the HHS Office of Inspector General? What is the HHS OIG Exclusions List?

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Fraud Medicare Medicare Medicaid 52

HIPAA Journal

MAY 18, 2023

The Department of Health and Human Services’ Office for Civil Rights is the main enforcer of HIPAA compliance; however, state Attorneys General also play a role in enforcing compliance with the Rules of the Health Insurance Portability and Accountability Act (HIPAA). 2022 New York EyeMed Vision Care $600,000 2.1 million 78.8

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HIPAA Compliance Ransomware Hospitals 94

Health Blawg

JANUARY 16, 2019

There’s an RFI out right now, published as part of the federales’ “ Regulatory Sprint to Coordinated Care ,” announced by HHS Secretary Alex Azar in mid-2018. There's an RFI out right now, published as part of the federales' “Regulatory Sprint to Coordinated Care,” announced by HHS Secretary Alex Azar in mid-2018.

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HIPAA Fraud Governance Payment Systems 60

Health Blawg

JANUARY 16, 2019

There’s an RFI out right now, published as part of the federales’ “ Regulatory Sprint to Coordinated Care ,” announced by HHS Secretary Alex Azar in mid-2018. There's an RFI out right now, published as part of the federales' “Regulatory Sprint to Coordinated Care,” announced by HHS Secretary Alex Azar in mid-2018.

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HIPAA Fraud Governance Payment Systems 60

Health Law Advisor

MARCH 7, 2023

In 2018, Congress passed requirements under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, requiring DEA to create a special registration for opioid addiction treatment via telehealth by October 2019. Impact on Pharmacies. 1301.28.

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Telemedicine COVID-19 FDA Compliance 52

Compliancy Group

JANUARY 25, 2022

The 2021 breach total nearly doubled the number of breaches in 2018. Let’s Simplify Compliance Learn how to protect your business from breaches in our upcoming webinar! We may look back at 2021 as the year when we moved from the era of identity theft to identity fraud. appeared first on Compliancy Group.

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HIPAA Ransomware Governance Fraud 98

HIPAA Journal

JANUARY 23, 2024

Theranos and Homes denied the allegations and threatened to sue Carreyrou; however, in 2018, Homes stepped down from her position as CEO, and following an FBI investigation the company was shut down. HHS-OIG Issues Notice of Exclusion HHS-OIG Inspector General Christi A.

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Fraud FDA Medicaid Medicaid 73

HIPAA Journal

APRIL 5, 2024

In 2018, the Supreme Court declined a review of the case, which was referred back to the District Court, then followed several years of back-and-forth litigation. law, mitigation expenses incurred to abate the risk of future fraud do not qualify as actual damages, therefore the plaintiffs would only be able to recover nominal damages.

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Fraud HIPAA Health Insurance Compliance 67

Innovaare Compliance

FEBRUARY 9, 2021

So it should come as no surprise that it’s even harder to achieve a five-star rating; in 2019, only 21 plans received a five-star rating whereas 24 healthcare payers received the top rating in 2018. A&G automation with single-click compliance. October 2018. . Digital transformation is no longer an option. CMS Newsroom.

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Medicare Medicare Medicaid Medicaid 40

MedTrainer

JULY 21, 2022

However, unauthorized access is causing more than just identity fraud. In January of 2018, Hancock Health of Indiana experienced a serious ransomware attack that forced their entire network to shut down. Since 2020, approximately 113 million people have been impacted by healthcare data breaches.

US Department of Health and Human Services 52

US Department of Health and Human Services HIPAA COVID-19 Compliance 52

Hall Render

NOVEMBER 28, 2023

7,872 2018 5,851 77.1% Due to CMS’s increasing concern “about program integrity issues within the hospice community, particularly (though not exclusively) potential and actual criminal behavior, fraud schemes, and improper billing,” it proposed to increase the risk screening category into which hospices were placed.

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Medicare Medicare Payment Systems Medicaid 40

New Jersey Healthcare Blog

JULY 22, 2022

Following a thorough review in compliance with Executive Order No. These include the purpose and scope, definitions, standard of care, licensee-patient relationship, provision of health care services through telemedicine or telehealth, records, prevention of fraud and abuse, and privacy and notice to patients. 13:44F with amendments.

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COVID-19 Vaccine Licensing COVID-19 Public Health 40

Drug & Device Law

JUNE 9, 2022

In our initial post, we focused on the exception to the presumption, which allows liability to be imposed if a plaintiff alleges and ultimately proves that the defendant manufacturer committed fraud on the FDA. Today’s post focuses not on the exception to the compliance presumption but on the antecedent issue of when the presumption applies.

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