Compliancy Group

AUGUST 23, 2023

In a shocking turn of events, a dental office manager from Worcester has been sentenced for participating in a scheme to defraud the Massachusetts Medicaid program, MassHealth. He was sentenced to 18 months in prison and one year of supervised release on August 10, 2023. Senior District Court Judge Timothy S.

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Medisys Compliance

JANUARY 30, 2023

Let us discuss the top compliance issues in the medical billing industry, shall we? Medicare and Medicaid: Medicare and Medicaid are government-funded healthcare programs that provide coverage to millions of Americans. Data Security: Data security is an increasingly important compliance issue for the medical billing industry.

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Med-Net Compliance

OCTOBER 27, 2022

The psychologist was convicted of four counts of healthcare fraud. He is scheduled to be sentenced on April 18, 2023, and faces a maximum penalty of 10 years in prison on each count. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.

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Nursing Homes Fraud US Department of Health and Human Services Nurses 59

Provider Trust

FEBRUARY 3, 2023

In a recent webinar, ProviderTrust took a look at impactful healthcare trends to monitor in 2023 and beyond. According to a January 2023 Washington Post article , nurses across California, Oregon, Michigan, and Minnesota have also threatened to protest or have already gone on employment strike. Do you have a compliance checklist?

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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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The Health Law Firm Blog

JANUARY 4, 2024

On November 6, 2023, the U.S. Department of Health and Human Services (HHS), Office of the Inspector General (OIG), released 91 pages of "General Compliance Program Guidance" (GCPG) on its website. This is the first compliance program guidance the OIG has released since 2008. The GCPG provides general compliance guidance, [.]

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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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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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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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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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Innovaare Compliance

OCTOBER 6, 2022

According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. And, in 2023, there will be more enrollees in MAPD than in original Medicare. Another highly anticipated change to begin on January 1, 2023 pursuant to the IRA is the $35 cap per month on out-of-pocket costs to Medicare beneficiaries.

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AIHC

AUGUST 30, 2023

Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM Due to the high volume of fraud schemes involving telemarketing revealed by the Department of Justice (DOJ) over recent years, it is important that providers heed “buyer beware” when engaging with a telemarketing firm. “If If it is too good to be true it probably isn't.”

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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. Moderated by David S.

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Med-Net Compliance

SEPTEMBER 20, 2022

The defendant was also convicted for falsification of records designed to prevent detection of this fraud and aggravated identity theft for falsely corresponding with Medicare under the name of another physician. Million Healthcare Fraud Scheme appeared first on Med-Net. He is scheduled to be sentenced on Jan.

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Innovaare Compliance

JUNE 8, 2023

The Centers for Medicare & Medicaid Services (CMS) has released new audit protocol changes for Medicare and Medicaid plans. 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.

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C&M Health Law

JANUARY 25, 2023

On December 29, President Joe Biden signed into law the Consolidated Appropriations Act, 2023 ( P.L. The PHE, which HHS Secretary Becerra renewed for the 11 th time on January 11, remains in effect through mid-April 2023. hospitalizations and emergency department visits) and to audit Medicare claims to assess potential fraud.

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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. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1

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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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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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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

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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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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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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Verisys

MAY 11, 2023

A big thanks to our compliance team, who monitors state, federal, and international updates. Arizona : Legislation to join the APRN Compact has passed the Senate as of 4/26/2023 and is currently being considered in the House. This training program would teach providers how to submit claims for reimbursement from Medicaid.

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Compliancy Group

SEPTEMBER 27, 2023

On September 25, 2023, Nuance Communications became the latest casualty of a vulnerability in Progress Software’s MOVEit Transfer software. Upon discovering the breach on May 31, 2023, Nuance wasted no time. Rated #1 on G2 “Compliancy Group makes a highly complex process easy to understand.” Please Wait.

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HIPAA Compliance Health Insurance Fraud 52

HIPAA Journal

JANUARY 23, 2024

Holmes, along with former company president Ramesh Balwani, were charged with criminal fraud for making false claims about the company’s technology and misleading investors. Balwani was convicted of conspiracy to commit wire fraud against Theranos’s patients and investors and was sentenced to 12 years and 11 months in prison.

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Compliancy Group

MARCH 8, 2023

How do people end up on the Medicaid Exclusion List, what are the consequences of being on the list, and can you ever get off the list? HIPAA authorized the OIG to provide guidance to the healthcare industry, to prevent fraud and abuse, and to promote high levels of ethical and lawful conduct. But nearly 74,000 people in the U.S.

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Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). Additional Opportunities for Integration through State Medicaid Agency Contracts (§ 422.107).

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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

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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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Health Law RX

JUNE 2, 2023

The Prior SafeCo Standard Until yesterday, defendants could seek dismissal of fraud claims based on the absence of scienter by relying on the two-part test codified by the Court in SafeCo Ins. A mistake is still a mistake, not fraud. of America v. 3] That test posed two questions. per 30-day supply). [9] per 30-day supply). [10]

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Fraud Governance Medicaid Medicaid 52

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs.

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COVID-19 Telemedicine Compliance Informed Consent 59

Hall Render

FEBRUARY 27, 2023

On February 7, 2023, the Department of Justice (“DOJ”) announced that it recovered over $2.2 This has been a growing trend in health care enforcement, and health care fraud remained the leading source of all FCA cases in 2022. Health Care Fraud Actions Medicaid. The Medicaid program was a target in 2022.

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Health Law RX

MARCH 30, 2023

A jury found the defendants to have submitted false claims for payment to Medicare, Medicaid, and other federally funded health care programs. Ultimately, on February 27, 2023, a jury found that this conduct led to the submission of 64,575 false claims to the government. As for the final judgment award, on March 17, 2023, the U.S.

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Overpayments Overpayment Fraud Governance 52

McGuire Wood

OCTOBER 2, 2023

13, 2023, the U.S. Further, if ancillary services are involved, there should be analysis to confirm compliance with the Stark Law and the AKS. If, however, an institution is concerned that its past practices have violated one of the fraud and abuse laws mentioned above, it may consider three avenues for a self-disclosure.

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Health Law RX

JULY 18, 2023

On June 27, 2023, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued its long-anticipated final rule amending the OIG’s civil monetary penalty (CMP) regulations as they relate to information blocking (CMP Final Rule or Rule). The CMP Final Rule was published in the Federal Register on July 3, 2023.

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Healthcare Law Blog

DECEMBER 12, 2022

Now, almost three years later, governmental entities have focused their attention on telehealth services and the potential for fraud and abuse. On October 13, 2022 , Health and Human Services (“HHS”) Secretary Xavier Becerra renewed the COVID-19 PHE and the PHE is now set to expire on January 11, 2023. Increased DOJ Activity.

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