American Medical Compliance

FEBRUARY 15, 2023

The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. It is everyone’s responsibility to combat fraud, waste, and abuse. No precise measure of healthcare fraud exists. Fraud schemes range from solo ventures to widespread activities of an institution or group.

Fraud 52

Fraud Medicare Medicare Compliance 52

Compliancy Group

MARCH 21, 2024

Office of Inspector General (OIG) of the Department of Health and Human Services (DHHS) oversees regulations covering federal programs offering benefits to healthcare organizations. All these tasks can seem daunting to even the most organized compliance officers. For example, how do they make the training engaging and memorable?

Compliance 52

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

Compliancy Group

MARCH 22, 2024

As a compliance officer or critical decision-maker, you can help your healthcare organization avoid exclusion from this valuable program by creating a comprehensive compliance program and using software to streamline your compliance processes. Over 65 million people in the U.S.

Medicare 52

Medicare Medicare Compliance Compliance Officers 52

MedTrainer

JANUARY 30, 2024

Healthcare compliance is a critical part of any organization’s business model. The professionals who manage compliance are the front lines of preventing medical errors, deterring fraud, and staying in good standing with federal payers like the Centers for Medicare and Medicaid Services (CMS).

Compliance 52

Compliance Compliance Officers Fraud Medicaid 52

Compliancy Group

FEBRUARY 26, 2024

A comprehensive hospital compliance work plan is pivotal for achieving these objectives. Hospital compliance officers, c-suite executives, and other decision-makers must constantly stay abreast of the latest developments in healthcare compliance.

Compliance 52

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

Provider Trust

MAY 16, 2024

This landmark milestone represents a continued commitment by ProviderTrust and its nearly 1,000 healthcare client organizations to ensure Medicare and Medicaid dollars are protected from fraud, waste, and abuse. Healthcare compliance plays an instrumental role in the success of the entire healthcare ecosystem.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

HIPAA Journal

MARCH 30, 2023

While the seven elements of a compliance program apply to all industries, they originated in the healthcare industry in the 1990s. This was in response to the growing level of healthcare fraud and abuse and an alleged “compliance disconnect” at the executive level in many hospitals and health systems.

Compliance 97

Compliance Compliance Officers Fraud HIPAA 97

Healthcare Law Blog

NOVEMBER 9, 2023

Thereafter, OIG said it planned to update existing industry-specific compliance program guidance (ICPG), which would include tailoring each to address fraud and abuse risk areas specific to a particular industry and describing the compliance measures that industry could take to reduce these risks [2].

Compliance 52

Compliance Compliance Officers Fraud Medicare 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. This three-pronged strategy focuses on educating patients and staff about how to avoid misconduct. In addition, CMS education and outreach focuses on preventing, detecting, and reporting Medicare fraud and abuse.

US Department of Health and Human Services 52

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

MedTrainer

JANUARY 10, 2024

The OIG is making major investments to systematically detect and prosecute fraud. And as JDSupra points out, t he OIG’s increased resources for compliance education may signal heightened audit and enforcement initiatives in the future. Listen to this podcast where my colleague, Hira Rashid, talks about anticipating policy changes.

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

YouCompli

DECEMBER 19, 2023

Last month, the Office of Inspector General (OIG) published a new, user-friendly, 91-page General Compliance Program Guidance (GCPG). Compliance Officer (page 38) : The OIG clarifies that compliance officers “have sufficient stature within the entity to interact as an equal of other senior leaders of the entity.”

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

Health Law RX

JANUARY 30, 2024

By maintaining a robust compliance program, healthcare companies are better able to identify potential red flags early and to prevent violations of fraud and abuse laws. Sellers that can demonstrate compliance with the GCPG will be more attractive to buyers as there will be less concern for hidden compliance issues.

Compliance 52

Compliance Due Diligence Fraud Governance 52

YouCompli

MAY 11, 2022

If you ask physicians what they think about coding and billing, most of them will tell you this: The rules do not make sense, are hard to understand, and are constantly changing. The doctor will be sentenced in July for multiple counts of healthcare fraud. Compliance officers should watch for: Follow the money.

Compliance Officers 52

Compliance Officers Fraud Compliance Medicare 52

Compliancy Group

FEBRUARY 7, 2024

You may have been hearing about UPIC (Unified Program Integrity Contractor) audits more often lately. CMS UPIC audits are designed to identify and prevent fraud, waste, and abuse within Medicare and Medicaid, ensuring that federal funds are used appropriately and that the services billed for are actually provided and are medically necessary.

Fraud 52

Fraud Compliance Medicare 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. Preparing for an OIG inspection is really about preventing issues like the Louisiana clinic was confronted with.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

MedTrainer

NOVEMBER 14, 2023

Financial Risks: They encompass losses from billing errors, fraud, and abuse claims, or failed investments related to healthcare provisions. By ensuring policies comply with applicable laws, regulations, and standards, you are providing operational guidance and setting standards for compliance. It’s broader.

Compliance 52

Compliance Compliance Officers Fraud Malpractice 52

MedTrainer

JANUARY 31, 2024

Who started the first healthcare compliance program? It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. However, it wasn’t until the mid-20th century that healthcare compliance regulations and programs began. What is Healthcare Compliance?

Compliance 52

Compliance Fraud Governance ACA 52

YouCompli

NOVEMBER 29, 2023

“As previous OIG compliance guidance(s) are retired to ‘archival’ status, we all should recognize that the original guidance may have been the most important document ever written for healthcare compliance professionals.” — Roy Snell In 1998, the Office of Inspector General (OIG) issued its first General Compliance Program Guidance (GCPG).

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

AIHC

MAY 31, 2022

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

Compliancy Group

JULY 12, 2023

Designating a compliance officer and compliance committee. Assigning a Designated Compliance Officer This person oversees the organization’s adherence to healthcare compliance standards. This individual or group plays a crucial role in implementing the compliance program effectively.

Compliance 52

Compliance Compliance Officers Fraud HIPAA 52

C&M Health Law

DECEMBER 18, 2023

Compliance policies should be developed under the direction and supervision of the compliance officer and compliance committee and should address the implementation and operation of an entity’s compliance program and processes. OIG’s updated take on the seven elements is briefly summarized below. (1)

Compliance 52

Compliance Compliance Officers Governance Overpayments 52

MedTrainer

OCTOBER 23, 2023

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. Technology is sure to play a critical role in the future of healthcare compliance. Learn more about how MedTrainer can streamline your compliance.

Compliance 52

Compliance Compliance Officers Fraud Governance 52

MedTrainer

FEBRUARY 1, 2024

A “red flag” in healthcare compliance refers to a warning sign or indicator that suggests a potential issue or violation of healthcare laws, regulations, or policies. These red flags are used to identify situations or activities that may raise concerns about fraud, waste, abuse, or non-compliance with healthcare regulations.

Compliance 52

Compliance Compliance Officers Fraud HIPAA 52

Healthcare Law Today

FEBRUARY 3, 2023

With only a few weeks until ATA2023 – the American Telemedicine Association’s 27th Annual Conference & Expo – our team looks forward to seeing people from across the telemedicine industry for conversations and insights about the future of digital health. ATA 2023: Join Us for Live Music and Libations!

Telemedicine 83

Telemedicine Fraud Compliance Officers Compliance 83

YouCompli

AUGUST 2, 2022

Different kinds of fraud and abuse have sprung up in relation to vaccination cards. Considerations for healthcare compliance officers. Compliance officers should make sure their organizations are delivering on their promises. Read more about how enforcement officials like to work with compliance professionals.)

COVID-19 Vaccine 52

COVID-19 Vaccine COVID-19 Nursing Homes Compliance Officers 52

MedTrainer

OCTOBER 17, 2023

Here are a few areas that a well-established compliance program can influence a healthcare organization. Prevention of Fraud and Abuse Corporate compliance works as a shield against potential fraud and abuse. Clear and comprehensive documentation forms the foundation of a compliance program.

Compliance 52

Compliance Compliance Officers Fraud Health Insurance 52

Healthcare Law Blog

FEBRUARY 9, 2024

million to resolve a lawsuit filed by the system’s former Chief Compliance Officer, Ronald Sherman. ChristianaCare denied these allegations and claimed that Sherman was granted the necessary authority in full compliance with the CIA. Delaware-based ChristianaCare Health System (ChristianaCare) [1] recently agreed to pay $47.1

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 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

MedTrainer

SEPTEMBER 8, 2023

Certified Professional Compliance Officer (CPCO): The CPCO certification is offered by the American Academy of Professional Coders and is tailored to professionals who manage and lead compliance programs. Certified Medical Compliance Officer (CMCO): The CMCO certification is offered by the Practice Management Institute.

Compliance 52

Compliance Compliance Officers HIPAA Regulatory Compliance 52

MedTrainer

AUGUST 31, 2023

Yet, navigating the intricacies of healthcare compliance can be daunting. It’s why we’ve compiled a series of the most common healthcare compliance FAQs and their answers. Any healthcare professional curious about compliance practices will find these answers helpful, insightful, and empowering.

Compliance 52

Compliance Compliance Officers HIPAA Fraud 52

YouCompli

MAY 25, 2022

To start, I want to be clear about how I’m defining “compliance culture” and how an organizational culture of compliance helps healthcare organizations serve patients and ensure healthy finances. Just look at the rampant, unreported fraud that took down Enron in the early 2000s. Compliance is making us do this.”).

Compliance 52

Compliance Compliance Officers Fraud Regulatory Compliance 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.

Nurses 52

Nurses Licensing Fraud Medicaid 52

YouCompli

JULY 27, 2022

Sharon Parsley, JD, MBA, CHC, CHRC , is a health law attorney, compliance officer, author, speaker, investigator, and problem solver. She has nearly 20 years of healthcare compliance and legal leadership experience, and she believes that mentorship and on-the-job training are critical to compliance professional success.

Compliance Officers 52

Compliance Officers Compliance Fraud Doctors 52

AIHC

MARCH 2, 2023

I do a lot of training of compliance officers and realize the time that is being spent could be improved. The article focusing on Resilient Leader talks about what traits are required being in a leadership role. As a leader, it wasn’t about me. In summary I have learned a lot about my own career path.

Compliance Officers 52

Compliance Officers Compliance Fraud Medical Billing 52

AIHC

APRIL 5, 2022

Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse. Diagnosis codes are an important compliance aspect of reporting medical necessity on the claim. Can the investigators “get it wrong”? They can, sometimes!

Fraud 52

Fraud Compliance Medicare Medicare 52

Innovaare Compliance

AUGUST 31, 2022

Fraud, waste and abuse probably represents one of the biggest risks to a healthcare organization because of the complexities of health service claims and the monetary amounts involved. . Conduct an annual risk assessment, led by the Compliance Officer, who understands the regulatory obligations impacting the Medicare program. .

Medicare 52

Medicare Medicare Compliance Officers Fraud 52

Healthcare IT Today

DECEMBER 20, 2022

Five former employees of Methodist Hospital in Memphis, TN, including a recently-licensed Registered Nurse, were indicted by a federal grand jury for allegedly selling medical information about car accident victims to personal injury attorneys and chiropractors. Mike Semel is the President and Chief Compliance Officer at Semel Consulting.

HIPAA 89

HIPAA Nurses Licensing Compliance 89