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8 Common Provider Credentialing Mistakes and How to Avoid Them

Verisys

3: Allowing a physician to treat patients before credentialing is completed Courts have held hospitals liable when a physician falsifies credentials, and the hospital fails to do its due diligence in verifying them. Therefore, due diligence requires background checks to identify current and historical adverse actions.

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Understanding Compliance for Healthcare Vendors

Provider Trust

Federal regulators such as the HHS-OIG, the Department of Justice (DOJ), the Centers for Medicare and Medicaid Services (CMS), and others have regulations and guidelines regarding the prohibition of reimbursements of federal healthcare dollars (Medicaid, Medicare, CHIPS, TriCare, and others) to excluded vendors.

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How HHS-OIG, Regulators Enforce Vendor Compliance

Provider Trust

Additionally, check out this HHS-OIG 2016 report, Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure , which revealed “vulnerabilities that could allow potentially fraudulent providers to enroll in the Medicare program.”. Recent cases of OIG enforcement and other fines, penalties related to vendors.

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Updated Compliance Tool for Developers of Mobile Health Apps

Hall Render

For example, reimbursement under Medicare and Medicaid for certain telemedicine services was significantly increased due to the COVID-19 pandemic. Hall Render blog posts and articles are intended for informational purposes only. For instance, many states have privacy and data protection laws that apply to mobile health apps.

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What Is Provider Credentialing?

MedTrainer

Listen to a candid discussion on lessons learned from the 2023 federal investigation that uncovered fraudulent medical practice nationwide in this on-demand webinar: Moving Forward From the Nursing Fraud Scheme. But how do you know which one to choose?