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Who Is Responsible For Compliance In Healthcare?

MedTrainer

Law by law, regulations were added, increasing the complexity of maintaining compliance for healthcare organizations. This is one of seven components recommended in the OIG’s compliance guidelines. For all-size organizations, the owner(s)/executive team has a legal and ethical responsibility to maintain compliance.

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What is a Certified Fraud Examiner (CFE)?

MedTrainer

CFEs collaborate with various stakeholders — including compliance officers, legal teams, auditors, and law enforcement agencies — to address fraud and compliance-related issues. The FCA prohibits submitting false or fraudulent claims for payment to government healthcare programs, such as Medicare and Medicaid.

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The History of Healthcare Compliance

MedTrainer

Key Changes in the History of Healthcare Compliance The face of healthcare compliance has changed dramatically in the last 100-plus years: Inception (Early 20th Century): Healthcare compliance began as a response to concerns about the quality of healthcare provided by medical practitioners.

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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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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 2022, survey finds Senate votes to end COVID-19 national emergency Why are 600+ rural hospitals at risk of closing?