Verisys

MARCH 8, 2024

Million Medicare and Medicaid Fraud Full Story Pharmacist Fraud Pharmacy Owner and Operations Manager Convicted of $2.3M With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network.

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Fraud Medicaid Medicaid Medicare 52

Provider Trust

MAY 9, 2023

What is a Medicaid Fraud Control Unit (MFCU)? Fraud and abuse are unfortunate realities of the healthcare industry. Hundreds of claims and investigations are carried out yearly to combat the growing number of providers, organizations, and entities contributing to fraud and abuse within state and federal healthcare programs.

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Fraud Medicaid Medicaid Nurses 52

Verisys

APRIL 2, 2024

Here is a round up of bad actors: Physician Fraud Physician pays $1.8M Million Medicare Fraud Scheme ( Full Story ) New York-Presbyterian/Brooklyn Methodist Hospital Settles Health Care Fraud Claims for $17.3 Here is a round up of bad actors: Physician Fraud Physician pays $1.8M

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Fraud Telemedicine Licensing Doctors 52

The Health Law Firm Blog

APRIL 18, 2022

Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 By George F. Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.].

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Licensing Medicaid Medicaid Fraud 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

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Fraud Medicaid Medicaid Medicare 52

Verisys

JANUARY 2, 2024

With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Secure your success by choosing Verisys.

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Fraud Licensing Doctors Medicare 52

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.

Fraud 52

Fraud US Department of Health and Human Services Medicaid Medicaid 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.

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Fraud Compliance Medicaid Medicaid 98

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. Providers also need an NPI to enroll in Medicare.

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Fraud HIPAA Medicare Medicare 97

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

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

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Fraud Medicaid Medicaid Medicare 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. 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.

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Fraud Medicare Medicare COVID-19 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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Licensing Governance Compliance Fraud 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. 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

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.

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COVID-19 Medicare Medicare Telemedicine 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

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. Medicare opt out.

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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. 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.

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Fraud Compliance 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? Who needs to monitor the OMIG List?

Medicaid 52

Medicaid Medicaid Fraud Licensing 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

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

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

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

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Medicare Medicare Medicaid Medicaid 52

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. Compliance evolved to include performance reporting and quality metrics.

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Compliance HIPAA Telemedicine ACA 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

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. ProviderTrust analyzed the public outpatient Medicare claims data of a large health system. billion in Medicare charges. Acquiring license information about providers can be difficult.

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Electronic Medical Records Licensing Medicare Medicare 52

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. Download Now What are Provider Privileges? 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

The Health Law Firm Blog

MAY 12, 2023

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

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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Compliance Fraud HIPAA Governance 52

Verisys

JUNE 8, 2023

Without technology automation, on average, it takes two to four months to complete the credentialing and enrollment for a newly hired licensed medical professional. Fraud Data Gap The U.S. trillion in 2021, making it highly susceptible to fraud. Let’s take a look at two areas where data gaps commonly occur.

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Compliance Fraud Licensing Medicare 52

Provider Trust

JULY 17, 2023

Medicare and Medicaid’s growing presence in managed care was also heavily discussed, with OIG urging healthcare organizations to become increasingly aware of risk adjustment payment scams. 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.

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Compliance Nursing Homes Nurses 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. However, verifying a provider’s credentials is essential.

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Licensing Medicaid Medicaid Governance 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.

Governance 52

Governance Licensing Malpractice Medicaid 52

Hall Render

NOVEMBER 15, 2023

Billing for Advanced Practice Professionals (“APPs”) has been a challenging area for providers and practitioners because of different and changing Medicare, Medicaid and state law requirements. This standard was interpreted and applied differently by various Medicare contractors and was difficult to review/audit.

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Medicare Medicare Medicaid Medicaid 40