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.

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Fraud Compliance Medicaid Medicaid 98

Provider Trust

JANUARY 26, 2022

It’s no secret–when fraud enters healthcare, things get risky. But how exactly does the HHS-OIG (Office of Inspector General), the main body responsible for conducting investigations into suspected fraudulent activity, address healthcare fraud and assess future risk of these bad actors? Department of Justice (DOJ), the U.S.

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Fraud US Department of Health and Human Services Medicaid Medicaid 52

The Health Law Firm Blog

FEBRUARY 15, 2022

Board Certified by The Florida Bar in Health Law On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Indest III, J.D., The office manager for Universal Smiles, a D.C.-based based dental practice was sentenced for her.

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Medicaid Medicaid Fraud Licensing 52

The Health Law Firm Blog

SEPTEMBER 20, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. Indest III, J.D., On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]

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Medicaid Medicaid Overpayments Overpayment 52

Provider Trust

JANUARY 18, 2023

In October 2022, the South Carolina Medicaid Fraud Control Unit (SCMFCU) arrested a 37-year-old South Carolina woman named Alyssa Beth Steele for working as a registered nurse despite not having a license. Pursuant to federal regulations, the SCMFCU is authorized to investigate and prosecute any acts of Medicaid provider fraud.

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Nurses Licensing Fraud Medicaid 52

The Health Law Firm Blog

AUGUST 24, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. Indest III, J.D., On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]

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Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

JULY 19, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. Indest III, J.D., On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]

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Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

JUNE 27, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. Indest III, J.D., On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]

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Medicaid Medicaid Overpayments Overpayment 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. Department of Health and Human Services responsible for administering and regulating healthcare programs such as Medicare and Medicaid.

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Compliance Fraud Medicaid Medicaid 52

The Health Law Firm Blog

MAY 16, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. Indest III, J.D., On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]

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Medicaid Medicaid Overpayments Overpayment 52

Verisys

NOVEMBER 8, 2023

The NPI improves the Medicare and Medicaid programs, other federal and private health programs, and the overall effectiveness and efficiency of the healthcare industry by simplifying administration and enabling the efficient electronic transmission of health information. Learn More About NPIs When Did NPI Numbers Begin?

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Fraud HIPAA Medicare Medicare 97

Provider Trust

MARCH 16, 2022

Exclusions are administrative actions that are placed upon an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or by one of the many agencies associated with SAM.gov. Additionally, there are varying, disparate State Medicaid exclusions sources that require periodic screening.

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Medicaid Medicaid Medicare Medicare 52

Provider Trust

SEPTEMBER 12, 2022

In 2006, New York’s Office of the Medicaid Inspector General (OMIG) was established as an independent office within New York State’s Department of Health to combat fraud and abuse in New York State’s Medicaid program. What is New York's OMIG List of Restricted and Excluded Providers?

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Medicaid Medicaid Fraud Licensing 52

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. The information confirms a provider is currently licensed to practice medicine.

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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. Non-compliance can lead to significant fines, legal battles, and the loss of license or accreditation.

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Compliance Licensing Governance Fraud 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?

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Nursing Homes COVID-19 Fraud Medicaid 52

Verisys

NOVEMBER 30, 2022

Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. organizations that receive any funds from Medicare, Medicaid, TRICARE, or other federal programs cannot afford to employ individuals or entities excluded from even one program. 38 Medicaid Sanctions.

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Regulatory Compliance Medicare Medicare 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. Who Can Search the NPDB?

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Licensing Malpractice Fraud Compliance 52

Healthcare Compliance Blog

MARCH 28, 2022

An Illinois licensed practical nurse (LPN) was convicted and sentenced for failing to administer lifesaving measures to a resident in a nursing home in 2017. Additionally, the LPN’s nursing license was suspended for an unspecified period of time. Discussion Points: Review your policies and procedures on CPR. Update as needed.

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Nurses Nursing Homes Licensing Fraud 59

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. Significant fines also can be levied by the Office of Inspector General (OIG) for overbilling Medicare and Medicaid.

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Compliance Informed Consent HIPAA Medical Billing 52

The Health Law Firm Blog

MARCH 26, 2024

It provides information and statistics on actions involving licensed health professionals through March 2021. Indest III, J.D., Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released.

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Licensing Nurses Fraud Medicaid 52

The Health Law Firm Blog

MARCH 11, 2024

It provides information and statistics on actions involving licensed health professionals through March 2021. Indest III, J.D., Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released.

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Licensing Nurses Fraud Medicaid 52

Pharmacy Law Blog

MARCH 13, 2018

She accused RS and Gobea of charging Tricare, Medicare and Medicaid excessively high rates for certain compounded drugs. To learn about a similar case involving a Florida compounding pharmacy, click here to read one of my prior blogs. fraud suit – judge.” The Relator’s FCA Suit. Sources: Wilson, Daniel. December 4, 2017).

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Fraud Governance Licensing FDA 52

The Health Law Firm Blog

AUGUST 23, 2023

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law All healthcare professionals, including pharmacists and pharmacies, should know the importance of good professional liability insurance. These policies protect them from the financial burden of legal expenses in case of any complaints or lawsuits filed against them.

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Licensing Fraud Medicaid Medicaid 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. However, verifying a provider’s credentials is essential.

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Licensing Medicaid Medicaid Governance 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. Under the Wage Parity Law, which is funded by Medicaid, aides are to be paid a minimum amount in total compensation.

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Medicaid Medicaid Governance Fraud 59

Verisys

JULY 20, 2023

An organization must verify all certifications and licenses for every provider who administers patient services. 4: Not updating and verifying information Healthcare practitioners need to renew their licenses and credentials on a regular basis, according to federal and state laws. Mistake No. Mistake No. Mistake No. Mistake No.

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Due Diligence Malpractice Licensing Hospitals 52

MedTrainer

MARCH 14, 2024

The specialist authenticates the provider’s education, work history, licenses, and other information during provider credentialing. Maintaining compliance helps protect against fraud, waste, and abuse. Meets compliance standards: Both processes verify a provider has met compliance standards.

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Malpractice Licensing Hospitals Compliance 52

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.

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Fraud US Department of Health and Human Services Compliance Medicaid 52

Provider Trust

JULY 17, 2023

To combat this fraud, waste, and abuse, the OIG introduced a three-part plan called the PRO framework to guide the oversight of nursing homes. This can help organizations better understand areas like the reporting of related party costs and how nursing homes use Medicaid funding to provide care.

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Compliance Nursing Homes Nurses Fraud 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.

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MedTrainer

JANUARY 12, 2024

Licensing and credentialing were introduced to regulate healthcare professionals and ensure minimum standards of care. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation.

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Compliance HIPAA Telemedicine ACA 52

Verisys

DECEMBER 5, 2023

State licensing boards verify practitioner license type and status. The Centers for Medicare & Medicaid Services (CMS) Medicare and state Medicaid lists show practitioners who have opted out of those programs. Here are some examples: Medical schools verify completion of education.

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Governance Licensing Malpractice Medicaid 52

The Health Law Firm Blog

DECEMBER 31, 2022

It provides information and statistics on actions involving licensed health professionals through March 2021. Indest III, J.D., Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released.

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Licensing Nurses Fraud Medicaid 52

Provider Trust

JULY 25, 2022

To eliminate fraud in your health ecosystem, you must stay compliant with federal and state requirements for referring and ordering physicians. Acquiring license information about providers can be difficult. See Our License Monitoring Solution. How can ProviderTrust help?

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Electronic Medical Records Licensing Medicare Medicare 52

The Health Law Firm Blog

DECEMBER 16, 2022

It provides information and statistics on actions involving licensed health professionals through March 2021. Indest III, J.D., Board Certified by The Florida Bar in Health Law The Florida Department of Health's Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released.

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Licensing Nurses Fraud Medicaid 52

Verisys

JANUARY 25, 2023

In short, an entity will lose the ability to service patients or members with Medicare or Medicaid insurance. By contrast, other credentials verification organizations (CVO) limit their searches by license type or to one or a few states. A heavy fine follows based on the length and engagement. states and jurisdictions.

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Compliance Fraud Telemedicine Licensing 52