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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Healthcare Compliance Blog

APRIL 27, 2022

A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. The hearing is scheduled for May 2, 2022. Train all staff on your compliance and ethics policies and procedures upon hire and at least annually.

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Medicaid Medicaid Compliance Governance 59

Healthcare Compliance Blog

FEBRUARY 2, 2022

The optician fraudulently received approximately $74,000 in Medicaid payments between 2016 and 2019 by billing for the optician services that were not provided. On January 27, 2022, he was sentenced to 90 days in state prison, followed by 5 years’ probation, and was ordered to pay $74,00 in restitution.

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Nursing Homes Fraud Medicaid Medicaid 59

Healthcare IT Today

JANUARY 2, 2024

In healthcare, unauthorized access translates to compliance failures, potential lawsuits, additional financial losses, and even weakened brand reputation and loss of customer trust. In 2022, DigiCert found that 47% of consumers stopped doing business with an organization once trust was lost in the organization’s digital security.

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Compliance US Department of Health and Human Services HIPAA Health Insurance 69

Compliancy Group

NOVEMBER 16, 2022

Under MACRA, the Centers for Medicare and Medicaid Services created regulations for healthcare providers’ use of health information technology. The MIPS score will be compared to the performance threshold determined yearly by the Centers for Medicare and Medicaid Services (CMS). . MIPS and MACRA 2022: Why Should I Care?

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Medicare Medicare HIPAA Medicaid 52

Healthcare Blog

AUGUST 23, 2023

It is critical for an organization to have strategies for promoting ethical behavior in healthcare compliance. Strategies Healthcare Organizations Can Use to Promote Ethical Behavior in Compliance Ensuring ethical practices in healthcare compliance is essential to corporate health and the integrity of your organization.

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Compliance Nurses Regulatory Compliance Medicaid 56

Med-Net Compliance

OCTOBER 21, 2022

The Office of Inspector General (OIG) has recently posted the False Claims Act (FCA) settlements for FY 2022 Q1–Q4 on the risk spectrum. OIG cases against these parties are closed without evaluating the effectiveness of any efforts the parties have made to ensure future compliance with Federal healthcare program requirements.

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Fraud Compliance Medicare Medicare 59

Innovaare Compliance

APRIL 29, 2022

The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of program audits in February 2022. The good and bad news regarding the changes promulgated for the 2022 program audit are: data submission is streamlined (good news) but programming revision and re-configuration of data fields are needed (bad news).

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Regulatory Compliance Compliance Medicare Medicare 52

Health Care Law Brief

FEBRUARY 2, 2024

While still subject to legislative approval, the Executive Budget incorporates the recently approved amendment (“Waiver Amendment”) to New York’s Medicaid Section 1115 Demonstration that includes $7.5 billion in Medicaid investments over the next three years. Services will be delivered via a two-tiered system.

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Medicaid Medicaid Medicare Medicare 52

Hall Render

FEBRUARY 27, 2023

billion in False Claims Act (“FCA”) related settlements and judgments in the federal fiscal year 2022. Whistleblowers continue to be one of the federal government’s greatest assets in FCA cases, as whistleblowers filed 652 qui tam suits in 2022 with recovery totaling $1.9 Health Care Fraud Actions Medicaid.

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Nursing Homes Fraud Medicaid Medicaid 40

Compliancy Group

FEBRUARY 16, 2024

We also covered two Medicaid fraud schemes , one resulting in billions of dollars in billing for medical supplies that were never received. for Medicaid Fraud In March 2014, the Maryland Board of Dental Examiners received complaints against Seyed Hamid Tofigh, DDS, claiming the dentist posed a risk of harm, and suspended his license.

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Verisys

DECEMBER 22, 2021

However, based on discussions with Verisys clients and prospects, most health plans are unprepared to meet the requirements due by January 1, 2022. Should a group health plan, insurer, or state agency find that time is running out on achieving regulatory compliance with H.R. The post Ensuring Provider Directory Compliance With H.R.

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Compliance Regulatory Compliance Healthcare information Technology Health Insurance 52

YouCompli

FEBRUARY 22, 2023

Raising prices on your hospital’s chargemaster can also raise your level of compliance grief. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. Compliance programs can create value for the organization by being the proactive force to mitigate these risks.

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Compliance US Department of Health and Human Services Overpayments Overpayment 52

Innovaare Compliance

OCTOBER 6, 2022

According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. In 2022, 48% of all eligible Medicare beneficiaries are enrolled in MAPD. New third-party marketing organization (TPMO) oversight requirements will go into effect on October 1, 2022.

Medicare 52

Medicare Medicare Compliance Public Health 52

Innovaare Compliance

JUNE 28, 2022

The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of CMS program audits in February 2022. Even though we’re six weeks from the end of the 2022 cycle, there’s still time to review the new and changed features of the CMS audit protocol (CMS 10717) for CY 2022. What to look for during an audit .

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Overpayments Overpayment Compliance Medicare 52

Healthcare Law Blog

OCTOBER 27, 2022

On October 21, 2022, the Centers for Medicare and Medicaid Services (CMS) announced changes to its Special Focus Facility (SFF) program, including new steps to address nursing home facilities that fail to graduate from the SFF program in a timely manner, or “yo-yo” back into non-compliance after graduating from the SFF program.

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Nursing Homes Medicaid Medicaid Nurses 96

Health Law Advisor

FEBRUARY 10, 2023

Department of Justice (DOJ) released its annual False Claims Act (FCA) enforcement statistics for fiscal year (FY) 2022, which ended on September 30, 2022. [1] 2] DOJ’s press release touts the FY 2022 as having the second highest number of settlements in history. 1] While total recoveries exceeded $2.2 1] [link]. [2]

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Fraud COVID-19 Governance Medicaid 52

Innovaare Compliance

JANUARY 3, 2022

The Centers for Medicare & Medicaid Services (CMS) began call-center monitoring for timeliness and accessibility in 2015 and has continued since. This is an increase from two for 2022. 2022 was an outstanding year for STAR performances. The average rating in 2022 is 4.37 New CMS Program audit protocol in 2022.

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Compliance Medicare Medicare Medicaid 40

AIHC

JANUARY 5, 2022

Written by: Joanne Byron , BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, COCAS, CORCM, OHCC, ICDCT-CM/PCS As a result of the 2021 Consolidated Appropriations Act, several No Surprises Billing Act regulations went into effect on January 1, 2022, for providers, facilities and air ambulance services.

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Medical Billing Health Insurance Hospitals Medicare 52

Hall Render

OCTOBER 31, 2022

The Centers for Medicare & Medicaid Services (“CMS”) has retooled guidance it armed surveyors with regarding how to survey skilled nursing facilities for compliance with the CMS staff vaccine requirements. CMS is replacing QSO memoranda 22-07-ALL Revised , 22-09-ALL Revised and 22-11-ALL. Background. Enforcement. Surveyor Review.

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Nurses Compliance COVID-19 COVID-19 Vaccine 40

Innovaare Compliance

DECEMBER 25, 2023

Summary of the HPMS Memo Generated by USHER (Inovaare’s AI-powered Compliance Assistant) The Centers for Medicare and Medicaid Services (CMS) issued a memorandum detailing several announcements relating to its 2024 CMS program audit.

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Medicare Medicare Medicaid Medicaid 52

Healthcare Blog

APRIL 13, 2023

As hospitals have become increasingly complex organizations, effective governance, risk, and compliance (GRC) strategies have become essential for ensuring patient safety and regulatory compliance. What are the Key Components of a Successful Governance, Risk, and Compliance (GRC) Strategy? Stay Alert !

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Governance Compliance Hospitals Regulatory Compliance 40

Healthicity

OCTOBER 5, 2022

The Office of Inspector General recently made Work Plan updates that impact price transparency rules, Medicaid fraud referrals, and inpatient rehabilitation. If you support compliance for hospitals or hospital systems, listen up! Have you heard? Our latest eBrief covers the updates you need to know.

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Fraud Medicaid Medicaid Compliance 98

Hall Render

FEBRUARY 21, 2022

The author of the bill claims that SNFs with the highest profit margins often have more compliance and quality issues. A new study compared unreimbursed Medicaid costs of non-profit and for-profit hospitals. The cost of long-term care services is on the rise, primarily because of labor costs. and SNF services 1.9%

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Medicaid Medicaid Hospitals Nurses 40

American Medical Compliance

DECEMBER 26, 2023

On December 27, 2020, the United States Congress adopted the No Surprises Act (NSA) as part of the Consolidated Appropriations Act of 2021, which has various provisions to assist in protecting customers against unexpected costs beginning January 1, 2022. To become certified, please visit us at: American Medical Compliance (AMC).

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Health Insurance Compliance Medical Billing Medicaid 52

MRO Compliance

JUNE 1, 2022

Each year HEDIS rating criteria is updated, meaning your organization needs to stay up-to-date on the latest news and trends for HEDIS compliance audits. Below is information on what your healthcare organization should know about HEDIS in 2022. Compliance with HEDIS specifications. What is HEDIS? What is a HEDIS audit?

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Medicare Medicare Compliance Medicaid 130

Hall Render

JANUARY 18, 2022

Amidst a nationwide nursing and skilled nursing facility staffing crisis, the Centers for Medicare & Medicaid Services (“CMS”) announced that additional information regarding nursing home staff numbers will be added to the January 2022 CMS Care Compare website. Staff Turnover.

Nurses 40

Nurses Nursing Homes Compliance Licensing 40

Innovaare Compliance

JUNE 21, 2023

The Inflation Reduction Act of 2022 has wide-ranging impact on payments for drugs used by Medicare beneficiaries, whether they are administered in the provider’s office (Part B) or used in the ambulatory setting (Part D). The post What you should know about Part B drug payments to comply with IRA 2022 appeared first on Inovaare.

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US Department of Health and Human Services Medicare Medicare Medicaid 52

American Medical Compliance

AUGUST 1, 2022

In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. This includes recommending compliance programs or trainings for staff. Get Certified.

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US Department of Health and Human Services Nursing Homes COVID-19 Medicare 52

Provider Trust

JUNE 15, 2022

In January 2022, an OIG enforcement action on Summa Health, Ohio resulted in a $19,880.28 The OIG alleged that Summa employed an individual on the Ohio Provider Medicaid Exclusion and Suspension List as well as an individual who was excluded from participation in Federal health care programs. Chief Compliance Officer, ProviderTrust.

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Medicaid Medicaid Compliance Compliance Officers 52

Health Law RX

JUNE 28, 2022

The Guidance is meant to assist covered entities with HIPAA compliance when the Telehealth Notification (defined below) is no longer in effect. The Telehealth Notification remains in effect until the Secretary of HHS declares the PHE period has ended or in July 2022, if there is not another renewal of the PHE determination. Next Steps.

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HIPAA Compliance COVID-19 Medicaid 52

Bill of Health

DECEMBER 6, 2023

While many insurers attempt to comply with this requirement, systemic problems like a lack of staff to communicate with providers and providers being overwhelmed with other administrative burdens prevent full compliance. In November 2022, Senator Tina Smith (D-Minn.) and Senator Ron Wyden (D-Ore.)

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Governance Medicaid Medicaid Medicare 144

Provider Trust

JANUARY 25, 2024

Ensuring the Financial Integrity of HHS Programs In fiscal year (FY) 2022, improper payments within healthcare programs like Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) were estimated at a staggering $131.6 With Medicaid, the challenges are equally formidable.

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Fraud Medicaid Medicaid Medicare 52

Compliance Now

MAY 5, 2022

The Centers for Medicare and Medicaid Services recently opened the much-anticipated federal Independent Dispute Resolution (IDR) Portal , a component of the No Surprises Act section of the Consolidated Appropriations Act of 2021 (the Act). By: Jessica Waltman, Principal, Forward Health Consulting.

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Medicaid Medicaid Medicare Medicare 189

Healthcare IT Today

DECEMBER 12, 2023

The latest policy update from The Centers for Medicare and Medicaid Services (CMS) adds key provisions to the December 2022 proposed rule requiring adoption of a new NCPDP SCRIPT standard version. To learn more about these standards, check out my blog on the initial e-prescribing updates announced by CMS in December 2022.

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Compliance Doctors Medicaid Medicaid 84

American Medical Compliance

AUGUST 1, 2022

In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. This includes recommending compliance programs or trainings for staff. Get Certified.

US Department of Health and Human Services 52

US Department of Health and Human Services COVID-19 Nursing Homes Medicare 52

Healthcare Compliance Blog

APRIL 29, 2022

On April 25, 2022, a former owner of multiple Texas adult day care centers was sentenced to 60 months in prison and ordered to pay $1,784,817.96 Discussion Points: Review your policies and procedures for operating an effective compliance and ethics program. She also operated a room and board business for Social Security recipients.

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Fraud Compliance Governance Medicaid 59