CMS.gov

NOVEMBER 2, 2018

CMS BLOG: Medicare for All? Just another name for a government-run, single payer system. Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare Part C. Medicare Part D. Medicare for All? Just another name for a government-run, single payer system. keya.joy-bush@….

Governance 55

Governance Medicare Medicare ACA 55

MedTrainer

NOVEMBER 15, 2023

In the United States, there are several compliance frameworks and entities that govern requirements for the healthcare industry. Each governing body oversees a different aspect of regulatory compliance. To understand which compliance frameworks govern which requirements, we need to break it down entity by entity.

Compliance Framework 52

Compliance Framework Governance Compliance Medicaid 52

YouCompli

AUGUST 22, 2023

Approximately 65 million Americans are enrolled in Medicare – about 34 million in traditional Medicare and the rest in Medicare Advantage. Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs.

Medicare 52

Medicare Medicare US Department of Health and Human Services Compliance 52

Healthcare Compliance Blog

FEBRUARY 22, 2022

Two women, one from Colorado and the other from Houston, have been sentenced in federal court for their roles a multi-million dollar Medicare Fraud Scheme. Each woman pled guilty to one count of conspiracy to commit healthcare fraud. The post Two Women Sentenced for Conspiracy to Commit Healthcare Fraud appeared first on.

Fraud 59

Fraud Medicare Medicare Governance 59

Healthcare Compliance Blog

APRIL 29, 2022

in restitution for her role in healthcare fraud, wire fraud, and theft of government funds. In March 2020 she pleaded guilty to one count of healthcare fraud, one count of wire fraud, and one count of theft of government funds. She used the money instead for her own personal gain. US Attorney Ashley C.

Fraud 59

Fraud Compliance Governance Medicaid 59

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Nursing Homes 59

Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

Fraud 40

Fraud Medicare Medicare Governance 40

Verisys

FEBRUARY 9, 2024

Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million Civil Judgment and Drug Treatment Center Enters Settlement to Pay $2.2

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare Compliance Blog

MARCH 2, 2022

An indictment was filed on February 25, 2022, against ten persons in Florida for their alleged roles in a $67 million healthcare fraud, wire fraud kickback, and money laundering scheme. Healthcare fraud and anti-kickback violations are each punishable by a maximum penalty of 10 years in prison.

Medicare 45

Medicare Medicare Fraud Compliance 45

Hall Render

SEPTEMBER 15, 2022

On September 2, 2022, the Office of the Inspector General (“OIG”) published a study assessing potential Medicare program integrity risks related to the proliferation of telehealth services during the first year of the COVID-19 pandemic. OIG identified 1,714 providers with billing practices deemed “high risk” to the Medicare program.

Telemedicine 40

Telemedicine Fraud Medicare Medicare 40

Hall Render

FEBRUARY 23, 2024

Whistleblowers continue to be one of the federal government’s greatest assets in FCA cases, with qui tam actions accounting for over $2.3 Health Care Fraud Actions Medicare Advantage. As the largest component of Medicare, Medicare Advantage (Medicare Part C) was a target in 2023. billion of the $2.68

Compliance 71

Compliance Governance Medicare Medicare 71

MedTrainer

FEBRUARY 12, 2024

government collected $2.2B Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. in settlements and judgments from healthcare organizations accused of filing false claims in fiscal 2022.

Compliance 52

Compliance Fraud Medicaid Medicaid 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

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. HHS’s suspension and debarment programs are vital to upholding integrity in Federal grants and contracts.

Fraud 52

Fraud Medicaid Medicaid Medicare 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. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

YouCompli

AUGUST 29, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. The audit also identified 1,714 providers whose billing for telehealth services for about a half million beneficiaries during the first year of the pandemic posed a high risk to Medicare.

Fraud 52

Fraud Medicare Medicare COVID-19 52

Provider Trust

AUGUST 9, 2022

The Health Care Fraud and Abuse Control Program (HCFAC) protects patients and consumers by combating healthcare fraud and abuse. This year’s 129-page report also includes information about the amounts deposited and appropriated to the Medicare Trust Fund, as well as the source of such deposits. Monetary Penalties. Of this $1.9

Fraud 52

Fraud Medicaid Medicaid Medicare 52

MedTrainer

JANUARY 31, 2024

federal government enacted the Federal False Claims Act (FCA) in 1863 during the American Civil War. It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. The need to combat fraud, waste, and abuse is what brought about the modern compliance program.

Compliance 52

Compliance Fraud Governance ACA 52

Healthcare Compliance Blog

FEBRUARY 15, 2022

billion in settlements and judgments have been recovered by the Department of Justice Department (DOJ) related to civil cases involving fraud and false claims in fiscal year 2021. Congress strengthened the False Claims Act by increasing incentives for whistleblowers to file lawsuits alleging false claims on behalf of the government.

Fraud 59

Fraud Governance Compliance Medicare 59

MedTrainer

FEBRUARY 5, 2024

In this blog, we’ll discuss the two processes and key differences between provider enrollment and credentialing. Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. So, what is the difference between provider enrollment and credentialing?

Licensing 52

Licensing Governance Compliance Fraud 52

MedTrainer

FEBRUARY 1, 2024

These programs help to promote lawful and ethical conduct within healthcare organizations and minimize the risk of legal violations, such as fraud, abuse, and other unethical behaviors. We’ll answer that question in this blog along with assessments of a good corporate compliance process. What is Corporate Compliance in Healthcare?

Compliance 52

Compliance Fraud Regulatory Compliance Regulations Compliance 52

Health Law RX

AUGUST 10, 2023

et al , the government contends that Teva funded the copays of Medicare patients using Copaxone, a multiple sclerosis drug, through donations to nonprofits running patient assistance programs. Teva in turn allegedly benefited from these donations by increasing the cost of Copaxone to the government. The court disagreed.

Governance 52

Governance Medicare Medicare Fraud 52

Healthcare Compliance Blog

APRIL 26, 2022

The compliance documents include special fraud alerts, advisory bulletins, podcasts, videos, brochures, and papers providing guidance on compliance with federal healthcare program standards. Voluntary Compliance: OIG has several self-disclosure processes to report fraud in HHS programs.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Compliance Medicaid 59

YouCompli

JULY 26, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. The audit also identified 1,714 providers whose billing for telehealth services during the first year of the pandemic posed a high risk to Medicare. million in Medicare fee-for-service payments.

Fraud 52

Fraud Compliance Medicare Medicare 52

Health Law RX

JUNE 2, 2023

2] Companies that regularly submit claims to the federal government are familiar with the complex maze of rules and regulations that often govern them. 6] These government payor programs limit the amount pharmacies can charge for generic medications to the “usual and customary” price. [7] of America v. per 30-day supply). [9]

Fraud 52

Fraud Governance Medicaid Medicaid 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

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

YouCompli

JULY 12, 2022

Wolf, MD provides enforcement action summaries for the YouCompli blog. In fact, Medicare beneficiaries used telehealth to receive 12 percent of their services during the first year of the pandemic. This was more than two in five Medicare beneficiaries. National fraud takedown: $1.1 In Fall 2021, the U.S.

COVID-19 52

COVID-19 Medicare Medicare Telemedicine 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

US Department of Health and Human Services 52

US Department of Health and Human Services Compliance Officers Compliance Fraud 52

MedTrainer

OCTOBER 23, 2023

In this blog post, we will explain healthcare compliance, shine light on its significance, and share best practices within the industry. Who Governs Healthcare Compliance? Office of Inspector General (OIG): Prevents fraud, waste, and abuse within the department’s vast array of Department of Health and Human Services (HHS) initiatives.

Compliance 52

Compliance Compliance Officers Fraud Governance 52

Healthcare Compliance Blog

FEBRUARY 7, 2022

A Michigan woman has pled guilty to stealing government funds that were designated to aid medical providers in the treatment of patients suffering from COVID-19 and acknowledged using the money for her own personal use. Issue: Misuse of allocated public funds can be seen as fraud, waste, and abuse of government funds.

COVID-19 59

COVID-19 Fraud Governance Compliance 59

Verisys

MAY 9, 2023

Reducing your organization’s fraud risk through internal policies and procedures that satisfy laws, regulations, and standards can help ensure quality of care and patient safety. These actions don’t necessarily result in automatic exclusion, but the OIG can choose to exclude for several reasons.

Compliance 52

Compliance Fraud Governance Licensing 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

MedTrainer

FEBRUARY 12, 2024

In this blog, we’ll outline why reporting healthcare non-compliance is non-negotiable and how software platforms make it easier to stay in compliance with the myriad regulations that govern good healthcare. For example, healthcare fraud or intentional non-compliance with regulations can lead to criminal charges.

Compliance 52

Compliance Licensing Governance Fraud 52

Hall Render

FEBRUARY 25, 2022

Although only a small minority of Children’s Hospital patients would be subject to cost-sharing under government health care programs, the OIG noted that the arrangement could implicate the AKS and Civil Monetary Penalties Law Beneficiary Inducement prohibition because the removal of cost? Your primary Hall Render contact.

Fraud 40

Fraud Hospitals Medicare Medicare 40

Healthcare Compliance Blog

MAY 19, 2022

million to settle allegations that it violated the False Claims Act by submitting false claims to Medicare. The voluntary disclosure and investigation revealed that from June 1, 2013, through May 31, 2019, the hospital submitted claims to Medicare for Intensive Cardiac Rehabilitation (ICR) services provided to Medicare beneficiaries.?Before

US Department of Health and Human Services 59

US Department of Health and Human Services Hospitals Medicare Medicare 59

Hall Render

FEBRUARY 4, 2022

Of that, $5 billion relates to health care fraud involving drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians. Health Care Fraud Actions. ” Medicare Part C. ” Medicare Part C. Boynton of the DOJ Civil Division.

Fraud 40

Fraud Governance Medicare Medicare 40