Verisys

FEBRUARY 2, 2023

. $ Billions Lost to Healthcare Fraud Annually Intentionally causing patient harm is less of a motivation than fraud that results in personal gain, but patients are often the collateral damage of fraud schemes. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Governance Compliance Licensing 52

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. But what exactly is considered fraud, waste, and abuse? Risk Assessment. Legislation and Congressional Requests.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Provider Trust

AUGUST 9, 2022

The Health Care Fraud and Abuse Control Program (HCFAC) protects patients and consumers by combating healthcare fraud and abuse. During the fiscal year 2021, the report states that the federal government won or negotiated over $5 billion in healthcare fraud judgments and settlements. Because of these efforts, close to $1.9

Fraud 52

Fraud Medicaid Medicaid Medicare 52

MedTrainer

JANUARY 12, 2024

In this blog post, we’ll outline who regulates healthcare compliance, how rules are enforced, and why organizations need a robust compliance platform to stay in the good graces of regulators. Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Provider Trust

FEBRUARY 3, 2023

The government and private whistleblowers have increasingly targeted PE firms’ portfolio companies and the firms themselves. One recent settlement we covered on our blog detailed the Massachusetts Attorney General’s case against South Bay Mental Health Centers. What about license verification and screening?

Compliance 52

Compliance Fraud Nurses Telemedicine 52

Hall Render

FEBRUARY 8, 2023

Department of Justice (“DOJ”) charged over two dozen individuals with wire fraud and conspiracy to commit wire fraud in connection with leading the alleged fraudulent scheme – each defendant faces up to 20 years in prison. Hall Render blog posts and articles are intended for informational purposes only.

Nurses 40

Nurses Licensing Fraud Governance 40

Verisys

FEBRUARY 14, 2024

Governance, Risk Management, and Compliance (GRC) in healthcare is an integrated approach that helps healthcare organizations manage their overall governance, enterprise risk management, and comply with regulatory requirements in a cohesive and aligned manner. What is healthcare data governance? What is GRC in Healthcare?

Governance 52

Governance Compliance Regulatory Compliance Compliance Framework 52

Provider Trust

JULY 26, 2022

On June 7, 2022, Theresa Pickering of Norcross, Georgia was indicted by a federal grand jury on federal charges of health care fraud, aggravated identity theft, and distribution of controlled substances. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud. According to the U.S.

Licensing 52

Licensing Fraud Compliance Nurses 52

Verisys

MAY 9, 2023

These regulatory programs ensure that reimbursement happens only for licensed practitioners and healthcare entities in good standing with the Office of Inspector General (OIG). Healthcare organizations must align their practices to comply with OIG regulations.

Compliance 52

Compliance Fraud Governance Licensing 52

Pharmacy Law Blog

MARCH 13, 2018

The federal judge refused the dismissal on the grounds that the government had sufficiently backed its allegations against both the company and its owner. The government had also adequately backed its allegations that RS knew it had been overpaid but had made no attempt to refund the difference to Tricare, according to the judge.

Fraud 52

Fraud Governance Licensing FDA 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. Situation One: Before the Pandemic   In April 2019, government officials announced Operation Brace Yourself: a fraud takedown related to telemedicine and durable medical equipment (DME).

Fraud 52

Fraud Medicare Medicare COVID-19 52

Verisys

DECEMBER 5, 2023

State licensing boards verify practitioner license type and status. An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs. Here are some examples: Medical schools verify completion of education.

Governance 52

Governance Licensing Malpractice Medicaid 52

Provider Trust

JULY 8, 2022

A holistic approach to exclusion monitoring and license verifications must include monitoring of disciplinary databases such as the National Practitioner Data Bank (NPDB). Its mission is to enhance healthcare quality, defend the public, and decrease healthcare fraud and misuse in the U.S. Healthcare Legislation & Regulations.

Licensing 52

Licensing Malpractice Fraud Compliance 52

Verisys

MARCH 1, 2024

FACIS® for Compliance and Safety: Verisys, through its flagship product FACIS® (Fraud Abuse Control Information System) , provides a gold standard dataset for sanction and exclusion screening.

Compliance 52

Compliance Fraud Licensing Governance 52

MedTrainer

JANUARY 26, 2024

In this blog, we will outline what is non-compliance in healthcare, highlight various non-compliance activities, and explore how healthcare compliance software plays a crucial role in combating non-compliance. Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry.

Compliance 52

Compliance Informed Consent HIPAA Medical Billing 52

MedTrainer

OCTOBER 4, 2023

These regulations and laws help maintain patient confidentiality, ensure quality care, and prevent fraud and abuse within the healthcare industry. These requirements are designed to protect patient rights, privacy, and safety, as well as to prevent fraud, abuse, and other improper practices within healthcare organizations.

Compliance 52

Compliance Fraud HIPAA Governance 52

Verisys

FEBRUARY 24, 2023

Worst of all, she learns two months later that her primary care physician, who’d suggested she consider surgery, had sanctions against his license in another state and shouldn’t have been practicing medicine in the first place. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Doctors Governance Licensing 52

Verisys

FEBRUARY 24, 2023

Worst of all, she learns two months later that her primary care physician, who’d suggested she consider surgery, had sanctions against his license in another state and shouldn’t have been practicing medicine in the first place. Estimates range from 3% – 10% of the entire federal healthcare funding lost to fraud, waste, and abuse.

Fraud 52

Fraud Doctors Governance Licensing 52

Verisys

JULY 27, 2023

This includes licensed and unlicensed staff members, as well as partners, investors, contingent workers, agents, and contractors you do business with. The safety of your patients depends on making sound hiring decisions and ensuring that the licenses of your staff are current.

Compliance 52

Compliance Due Diligence Licensing Fraud 52

Verisys

JULY 5, 2023

This includes licensed and unlicensed staff members, as well as partners, investors, contingent workers, agents, and contractors you do business with. Not only does thorough screening and rigorous continuous monitoring help ensure quality employees, but it also provides 360-degree transparency.

Compliance 52

Compliance Due Diligence Licensing Fraud 52

Verisys

NOVEMBER 30, 2022

Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. License Verification & Monitoring. State Licensing Boards and Agencies. Learn more about how Verisys can assist your HCOs in meeting all government and regulatory standards. Credentialing.

Regulatory Compliance 52

Regulatory Compliance Medicare Medicare Medicaid 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. Situation One: Before the Pandemic   In April 2019, government officials announced Operation Brace Yourself: a fraud takedown related to telemedicine and durable medical equipment (DME).

Fraud 52

Fraud Compliance Medicare Medicare 52

Provider Trust

AUGUST 16, 2023

Despite such mandates, OIG investigations over the past five years have found that vendors are accountable for much of the healthcare ecosystem’s fraud, waste, and abuse. Over the past several years, OIG has discovered that a significant amount of fraud, waste, and abuse occurs within the vendor domain.

Fraud 52

Fraud Compliance Licensing Compliance Officers 52

MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. Licensing and credentialing were introduced to regulate healthcare professionals and ensure minimum standards of care. Compliance in healthcare began to encompass billing, fraud, and abuse prevention.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

MedTrainer

AUGUST 31, 2023

Healthcare compliance refers to the process of adhering to the laws, regulations, and ethical standards that govern the healthcare industry. It also helps prevent fraud, abuse, and errors, ensuring the delivery of high-quality care and ethical decision-making. What Is Healthcare Compliance? What Are the Consequences of Non-Compliance?

Compliance 52

Compliance Compliance Officers HIPAA Fraud 52

Verisys

NOVEMBER 14, 2023

Primary source verification must be done to confirm a provider’s education, professional license and certifications, medical training, work history, references, and more. Provider information should be continuously monitored for any changes to exclusion or license status.

Licensing 52

Licensing Medicaid Medicaid Governance 52

MedTrainer

MARCH 14, 2024

The specialist authenticates the provider’s education, work history, licenses, and other information during provider credentialing. Whether it’s government regulation or healthcare facility requirements is a matter. Maintaining compliance helps protect against fraud, waste, and abuse.

Malpractice 52

Malpractice Licensing Hospitals Compliance 52

Health Law Blog

MAY 22, 2018

Substance Abuse Treatment Center Fraud Scheme Results in Guilty Plea. The Department of Justice recently announced the guilty plea of two individual alcohol and substance abuse treatment center owners for their participation in what DOJ labeled a “multi-million dollar health care fraud and money laundering scheme.”

Fraud 52

Fraud Overpayments Overpayment Licensing 52

Provider Trust

AUGUST 9, 2023

Grimm, the OIG continues its tireless efforts to uncover instances of fraud, waste, and abuse within HHS programs. OIG continues to work tirelessly to identify instances of fraud, waste, and abuse and prosecute offenders. Led by acting Inspector General Christi A. What is the HHS-OIG Semiannual Report to Congress?

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

YouCompli

JULY 12, 2022

Wolf, MD provides enforcement action summaries for the YouCompli blog. National fraud takedown: $1.1 Department of Justice (DOJ) announced a national health care fraud enforcement action involving over $1.4 billion alleged losses, telemedicine related fraud accounted for the vast majority at $1.1 In Fall 2021, the U.S.

COVID-19 52

COVID-19 Medicare Medicare Telemedicine 52

Healthcare Compliance Blog

MARCH 31, 2022

The agencies received millions of dollars in funding from Medicaid, which is funded in part by the federal government, and much of that money was meant to pay the wages and benefits of their aides. It can also include health insurance, pension plans, or educational assistance.

Medicaid 59

Medicaid Medicaid Governance Fraud 59

YouCompli

DECEMBER 7, 2022

These exclusions are generally related to criminal activity like fraud or healthcare-related misconduct. Felony convictions for other healthcare-related fraud, theft, or other financial misconduct. Excluded people are ineligible to perform services that are reimbursed by federal healthcare programs. Patient abuse or neglect.

Fraud 52

Fraud US Department of Health and Human Services Compliance Medicaid 52

Healthcare Compliance Blog

JANUARY 17, 2022

The nurse is presumed innocent and entitled to a fair trial at which the government has the responsibility of proving guilt beyond a reasonable doubt. Licensed staff who have access to controlled medications may commit fraud and theft of controlled substances if they develop a substance abuse problem.

Nurses 59

Nurses Fraud Licensing Governance 59

Verisys

AUGUST 24, 2023

Background Screening Report Limitations Federal and state laws govern the information you receive when you run a background check. Some arrests and convictions are sealed from government agencies, so they will not appear on a background check. Don’t take the risk. Sealed or expunged records. Salary-dependent rules.

Governance 52

Governance Fraud Licensing Compliance 52

MedTrainer

FEBRUARY 27, 2024

And like any healthcare professional, HHAs must adhere to the compliance standards that govern quality care. They are not licensed to diagnose or treat beyond their certifications and state regulations, but they often observe changes in the patient’s condition that can be life saving.

Compliance 52

Compliance HIPAA Fraud Licensing 52

Verisys

AUGUST 10, 2023

Background Screening Report Limitations Federal and state laws govern the information you receive when you run a background check. Some arrests and convictions are sealed from government agencies, so they will not appear on a background check. Don’t take the risk. Sealed or expunged records. Salary-dependent rules.

Governance 52

Governance Fraud Licensing Compliance 52

AIHC

JUNE 6, 2023

Algorithms perform relatively well on knowledge-based tests despite the lack of domain-specific training; ChatGPT achieved ~ 66% and ~ 72% on Basic Life Support and Advanced Cardiovascular Life Support tests, respectively, and performed at or near the passing threshold on the United States Medical Licensing Exam.

Compliance 59

Compliance Medical Billing HIPAA Due Diligence 59