American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. To become certified, please visit us at: American Medical Compliance (AMC).

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Fraud Medicare Medicare Compliance 52

Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. As Medicare Advantage continues to grow, the risk of provider-level fraud will also increase.

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Fraud Medicare Medicare US Department of Health and Human Services 52

American Medical Compliance

FEBRUARY 15, 2023

The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Fraud schemes range from solo ventures to widespread activities of an institution or group.

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Fraud Medicare Medicare Compliance 52

HIT Consultant

JANUARY 3, 2023

But they have also expanded the attack surface at these organizations and increased the level of risk and vulnerabilities that could result in direct loss of proprietary information, direct financial damage including theft and fraud, and potential loss of life (in addition to regulatory fines and brand damage) the healthcare sector faces.

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Compliance Ransomware Fraud Regulatory Compliance 52

Health Law Advisor

AUGUST 25, 2023

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. These regulations were proposed to implement portions of the New York State 2020-2021 Budget Bill amending the mandatory compliance program requirements. New York Social Services Law § 363-d.

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Compliance Overpayments Overpayment Compliance Officers 52

Healthcare Law Blog

FEBRUARY 3, 2023

New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R. Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1]

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Medicaid Medicaid Compliance Overpayments 52

Provider Trust

AUGUST 9, 2023

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released its latest 2023 Spring Semiannual Report to Congress, providing a comprehensive overview of its activities from October 2022 to March 2023. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

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Nursing Homes COVID-19 Fraud Medicaid 52

Hall Render

NOVEMBER 10, 2023

On November 6, 2023, the Office of Inspector General (“OIG”) for the U.S. Department of Health and Human Services (“HHS”) issued new General Compliance Program Guidance (“GCPG”) for members of the health care compliance community and other health care stakeholders.

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Compliance Compliance Officers Fraud Governance 40

Healthcare IT Today

JANUARY 2, 2023

As we head into 2023, we wanted to kick off the new year with a series of 2023 Health IT predictions. We are going to see an increased demand for privacy-preserving technology in 2023, and therefore more investment in the space. during 2023. Check out our community’s healthcare Security and Risk predictions.

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Ransomware Fraud Compliance Telemedicine 121

YouCompli

JANUARY 18, 2023

Featured speakers : Eric Gold , Chief, Massachusetts Attorney General’s Office Healthcare Division; Jennifer Goldstein , Managing Attorney, Medicaid Fraud Division, Massachusetts Attorney General’s Office; and Steven Sharobem , Assistant US Attorney, District of Massachusetts. Priorities for Massachusetts’s Medicaid Fraud Division.

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Fraud COVID-19 Compliance Medicaid 52

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. He was sentenced to 18 months in prison and one year of supervised release on August 10, 2023.

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Fraud Medicaid Medicaid Governance 52

C&M Health Law

DECEMBER 18, 2023

Department of Health and Human Services (HHS) published the General Compliance Program Guidance (GCPG) on November 6, 2023. The GCPG provides updated descriptions of the seven elements of an effective compliance program that health care entities have long relied upon. The Office of the Inspector General (OIG) of the U.S.

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Compliance Compliance Officers Governance Overpayments 52

Provider Trust

MARCH 13, 2023

On January 25, 2023, the US Department of Justice joined with the Federal Bureau of Investigation (FBI) and the US Department of Health and Human Services Office of Inspector General (HHS-OIG) to launch a multi-state law enforcement action to apprehend individuals involved in this fraudulent nursing degree scheme. Are you in Florida?

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Fraud US Department of Health and Human Services Licensing Compliance Officers 52

Verisys

MAY 3, 2023

7 Core Elements of Healthcare Compliance Plan and How to Measure Them Healthcare compliance regulations are complex and ever-changing, but are an essential part of any healthcare organization’s effort to provide safe, high-quality care for patients. What is an effective healthcare compliance program?

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Compliance Compliance Officers ADA Governance 52

Innovaare Compliance

JUNE 8, 2023

These changes, which went into effect on January 1, 2023, are designed to ensure health plans are accurately reporting their costs and that they are not overcharging the government. Review your financial arrangements: Make sure that your financial arrangements with providers are in compliance with CMS regulations.

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Medicaid Medicaid Medicare Medicare 52

AIHC

JUNE 6, 2023

OpenAI’s ChatGPT 2023 & the National Institutes of Health AI is developing at lightning speed. The government’s National Institutes of Health (NIH) published an article in February 2023 entitled “ Opportunities and risks of ChatGPT in medicine, science, and academic publishing: a modern Promethean dilemma. ”

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Compliance Medical Billing HIPAA Due Diligence 59

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. The British government decided to take action and offered citizens a bounty to redeem for dead cobras.

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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. The British government decided to take action and offered citizens a bounty to redeem for dead cobras.

Compliance 52

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

AIHC

JUNE 6, 2023

OpenAI’s ChatGPT 2023 & the National Institutes of Health AI is developing at lightning speed. The government’s National Institutes of Health (NIH) published an article in February 2023 entitled “ Opportunities and risks of ChatGPT in medicine, science, and academic publishing: a modern Promethean dilemma. ”

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Compliance Medical Billing HIPAA Due Diligence 52

Hall Render

FEBRUARY 23, 2024

billion in False Claims Act (“FCA”) settlements and judgments during the 2023 federal fiscal year. In addition to the record-setting number of settlements and judgments, whistleblower activity continues to grow with over 712 qui tam lawsuits filed in 2023, averaging more than 13 new cases every week. billion of the $2.68

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Compliance Governance Medicare Medicare 71

Healthcare IT Today

JANUARY 19, 2024

According to the 2023 ForgeRock Breach Report , healthcare has consistently ranked as the most targeted industry by cybercriminals for the past five years. The 2023 Verizon Breach Report further highlights vulnerabilities with the healthcare sector, identifying web applications as the number one attack vector.

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Fraud Governance Ransomware Compliance 84

Innovaare Compliance

MARCH 24, 2024

The Importance of Payment Integrity Payment integrity is crucial for health plans to control costs, reduce fraud, waste, and abuse (FWA), and ensure the accuracy of healthcare payments. billion in healthcare fraud judgments and settlements. billion in healthcare fraud judgments and settlements.

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Fraud Health Insurance Compliance Medicaid 52

YouCompli

AUGUST 29, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. As FWA continues to emerge, and poses more of a risk to organizational compliance, professionals should become familiar with some of the potential areas of noncompliance associated with telehealth.

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Fraud Medicare Medicare COVID-19 52

YouCompli

JULY 26, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. As FWA in telehealth continues to emerge, and poses more of a risk to organizational compliance, professionals should become more familiar with it – and then work to curb it.

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Fraud Compliance Medicare Medicare 52

HIPAA Journal

JANUARY 30, 2023

The National HIPAA Summit is the leading forum on healthcare EDI, privacy, breach notification, confidentiality, data security, and HIPAA compliance, and the deadline for registration for the Virtual 40th National HIPAA Summit is fast approaching.

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US Department of Health and Human Services HIPAA Compliance Medicaid 81

Health Law Advisor

FEBRUARY 10, 2023

Lowest Total Recoveries Since 2008 Record-Shattering Number of New Cases Filed Health Care and Life Sciences Cases Continue to Dominate On February 7, 2023, the U.S. The total recoveries in fraud cases brought with respect to the health care and life sciences industries fell to the lowest level since 2009. Last year, $1.2

Fraud 52

Fraud COVID-19 Governance Medicaid 52

YouCompli

AUGUST 22, 2023

Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs. This is a major shift in coverage patterns – and with it comes a shift in compliance scrutiny as well.

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Medicare Medicare US Department of Health and Human Services Compliance 52

Healthcare Law Today

FEBRUARY 3, 2023

Director of Policy & Regulatory Affairs, Homeward Cecily Harris, Deputy General Counsel, Wheel Telemedicine Fraud & Abuse Enforcement Foley Partner Lisa Noller, Chair of the firm’s Government Enforcement & Investigations Practice will join a fireside chat on telemedicine fraud & abuse enforcement trends.

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Telemedicine Fraud Compliance Officers Compliance 83

Health Law Advisor

APRIL 13, 2023

On March 22, 2023, the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) updated its Frequently Asked Questions (“FAQs”), drafting 13 FAQs aimed at easing the transition from COVID-era flexibilities to the end of the Public Health Emergency (“PHE”) on May 11, 2023.

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Public Health Fraud COVID-19 Medicaid 52

Health Law RX

JUNE 27, 2023

the Court held that, despite declining to intervene at the outset of a case, the Government retains the authority to intervene later, including for the purposes of seeking dismissal pursuant to and consistent with Federal Rule 41(a) ( U.S. 21-1052, 2023 WL 4034314, at *2 (U.S. June 16, 2023)). SuperValu Inc., 1391, 1401 (U.S.

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Governance Fraud Compliance 52

AIHC

MAY 17, 2023

This article addresses various forms of fraud and how criminals’ prey on compromised citizens. Contributions to this article are made from the American Institute of Healthcare Compliance Volunteer Education Committee’s interview of a law enforcement official. SNAP Fraud Food assistance is generally referred to as SNAP or food stamps.

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Health Outcomes Fraud Compliance Governance 52

YouCompli

OCTOBER 17, 2023

Recent Upcoding – Civil Cases Here are some recently announced E&M upcoding cases: In June 2023, the U.S. The government alleged that the provider knowingly caused false claims to be submitted by billing for E&M services at a higher rate of reimbursement than they were entitled to. Sentencing is scheduled for November 2023.

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COVID-19 Compliance Fraud Doctors 52

McGuire Wood

OCTOBER 2, 2023

13, 2023, the U.S. times the amount the government believed was due to improper billing, after a voluntary disclosure to the Department of Justice (DOJ). Further, if ancillary services are involved, there should be analysis to confirm compliance with the Stark Law and the AKS. Care in email and transactional slides is warranted.

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Fraud Governance Compliance Medicare 52

Health Law RX

JUNE 2, 2023

2] Companies that regularly submit claims to the federal government are familiar with the complex maze of rules and regulations that often govern them. 6] These government payor programs limit the amount pharmacies can charge for generic medications to the “usual and customary” price. [7] A mistake is still a mistake, not fraud.

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Fraud Governance Medicaid Medicaid 52

Health Law RX

MARCH 30, 2023

13-3003, the government alleged that an ophthalmology distributor and its founder violated the FCA by providing kickbacks to physicians in the form of travel and entertainment activities, encouraging the use of the company’s ophthalmic supplies and equipment. As for the final judgment award, on March 17, 2023, the U.S.

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Overpayments Overpayment Fraud Governance 52

Healthcare Law Today

JANUARY 11, 2023

On January 4, 2023, the Department of Justice issued a press release stating that Jet Medical Inc. The government also alleged that Jet Medical did not conduct an investigational study regarding the device’s safety and effectiveness when used as intended. Food and Drug Administration (FDA) prior to distribution.

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FDA Governance Medicare Medicare 59

Healthcare IT Today

APRIL 25, 2024

For a healthcare entity, the data and information are viewed as extremely valuable as it includes PII as well as other health information that can be used for insurance fraud and identity theft. Troy is a frequent speaker and highly published thought leader on IT compliance and cybersecurity topics.

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Ransomware Compliance Fraud Governance 99