Remove ACA Remove Compliance Officers Remove Fraud Remove Medicare
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What is a Certified Fraud Examiner (CFE)?

MedTrainer

In healthcare especially, fraud is something responsible providers need to be on the lookout for. It’s why many organizations choose to work with a Certified Fraud Examiner as part of their ongoing efforts to remain responsible and compliant with financial best practices. What is a Certified Fraud Examiner?

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Who Started the First Healthcare Compliance Program?

MedTrainer

Who started the first healthcare compliance program? It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. However, it wasn’t until the mid-20th century that healthcare compliance regulations and programs began. What is Healthcare Compliance?

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Which Compliance Framework Governs the Healthcare Industry?

MedTrainer

It conducts audits, investigations, and evaluations to ensure efficiency and integrity in HHS programs, including Medicare and Medicaid. The OIG also enforces standards for healthcare providers and suppliers to prevent fraud and imposes penalties for non-compliance. Designate a compliance officer and/or compliance committee.

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The History of Healthcare Compliance

MedTrainer

Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Compliance in healthcare began to encompass billing, fraud, and abuse prevention. Compliance efforts expanded to encompass EHR security.

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The Importance of Internal Healthcare Compliance Audits

MedTrainer

Medicare Access and CHIP Reauthorization Act (MACRA): Promotes value-based care and rewards healthcare providers for quality and performance. Affordable Care Act (ACA): Ensures access to affordable healthcare and prevents fraud and abuse.

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What Is Medical Auditing?

MedTrainer

They review healthcare claims and billing practices to ensure accuracy, detect fraud or abuse, and assess compliance with the payer’s policies and guidelines. Federal Government Audits These audits are performed by government agencies such as the Centers for Medicare and Medicaid Services (CMS).

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Health Provider News

Hall Render

in Financing for Medical Office Building in Utica, New York Jacobi hospital saw 20% of its nurses quit in 2022. in 2022, survey finds Senate votes to end COVID-19 national emergency Why are 600+ rural hospitals at risk of closing? buys industrial property in Rancho Cordova for $5.12