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?

Fraud 52

Fraud US Department of Health and Human Services Medicaid Medicaid 52

AIHC

SEPTEMBER 21, 2023

Written by Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS This article addresses the Information Blocking Final Rule regarding enforcement, associated Civil Monetary Penalties (CMPs) and entities subject to these penalties. Information blocking is defined in § 171.103.

HIPAA 59

HIPAA Compliance Nurses Fraud 59

Provider Trust

APRIL 26, 2023

An increasing trend of nurse strikes and hospital staffing shortages across the country in early 2023 has led many healthcare organizations to turn to travel nurses and staffing agencies to fulfill their workforce needs. But working with staffing agencies and travel nurses comes with its own unique set of compliance risks.

Licensing 52

Licensing Nurses Compliance COVID-19 52

HIPAA Journal

DECEMBER 31, 2022

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was introduced to simplify the administration of healthcare, eliminate wastage, prevent healthcare fraud, and ensure employees could maintain healthcare coverage between jobs. Unauthorized release of PHI to individuals not authorized to receive the information.

HIPAA 132

HIPAA Due Diligence Compliance Fraud 132

Hall Render

NOVEMBER 28, 2023

Agencies that fail to submit their quality data will have an additional 2% deducted from their reimbursement as indicated below. CMS also dismissed concerns about agencies operating with negative profit margins. 7,215 2021 5,532 77.5% More importantly, the number of agencies operating with a negative margin has also declined.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Healthcare IT Today

FEBRUARY 2, 2023

It has given every indication that it intends to investigate fraud, waste, and abuse more robustly in the foreseeable future. To that end, the agency doubled its budget for audits in 2022. The Justice Department has joined the fraud case against one large national insurer. These actions are more than just saber-rattling.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

AIHC

NOVEMBER 29, 2023

Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes indicates that in 2021 the U.S. 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. Why this Trend of Value-Based Care?

Medicare 59

Medicare Medicare Medicaid Medicaid 59