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. But what exactly is considered fraud, waste, and abuse?

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Fraud Compliance Medicaid Medicaid 98

Compliancy Group

AUGUST 31, 2023

Healthcare compliance laws play a vital role in safeguarding patients’ rights, preventing fraud and abuse, and maintaining the integrity of healthcare systems. Let’s delve into the importance of healthcare compliance laws and regulations, their impact on providers and organizations, and the guidelines governing their implementation.

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YouCompli

DECEMBER 19, 2023

Exclusions (page 26) : OIG recommends that any entity participating in the federal Medicaid program should check the state Medicaid program exclusion list for each applicable state. In organizations where compliance reports to legal, conflicts of interest exist and can create barriers that lead to timing and resource inefficiencies.

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Compliance Compliance Officers Medicaid Medicaid 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).

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Compliance Compliance Officers Medicaid Medicaid 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. Centers for Medicare and Medicaid (CMS) : Evaluates providers’ adherence to state/federal regulations and guidelines at both the individual and organizational levels.

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Compliance Compliance Officers Fraud Governance 52

MedTrainer

FEBRUARY 1, 2024

A corporate compliance program in healthcare is a comprehensive set of policies, procedures, and practices that healthcare organizations establish and maintain to ensure that they operate compliant with all applicable laws, regulations, and ethical standards. Why do healthcare facilities use corporate compliance programs?

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Compliance Fraud Regulatory Compliance Regulations Compliance 52

Medisys Compliance

JANUARY 30, 2023

Let us discuss the top compliance issues in the medical billing industry, shall we? HIPAA: The Health Insurance Portability and Accountability Act( HIPAA) is a federal law that establishes the national standards for protecting the privacy and security of individuals’ personal health information ( PHI).

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Compliance Medical Billing Medical Billing Outsourcing HIPAA 52

MedTrainer

SEPTEMBER 20, 2023

This means your organization must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations. Accreditation.

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Medicaid Medicaid Medicare Medicare 97

MedTrainer

OCTOBER 4, 2023

To ensure organizations meet these standards, federal healthcare compliance requirements have been put in place. These regulations and laws help maintain patient confidentiality, ensure quality care, and prevent fraud and abuse within the healthcare industry. Office of Inspector General (OIG).

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Compliance Fraud HIPAA Governance 52

MedTrainer

JANUARY 30, 2024

Compliance is Mandatory for Federal Programs One constant is that organizations and facilities that participate in federal healthcare programs, such as Medicare and Medicaid, must have a compliance program. Laboratories: Clinical laboratories that perform tests covered by Medicare or Medicaid.

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Governance Compliance Nursing Homes Medicaid 52

MedTrainer

JANUARY 12, 2024

The protection of patient data, adherence to privacy regulations like the Health Insurance Portability and Accountability Act (HIPAA) in the United States, and the prevention of cyber threats have become paramount concerns. Compliance in healthcare began to encompass billing, fraud, and abuse prevention.

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MedTrainer

JANUARY 26, 2024

Here are some common non-compliance activities: Failure to Maintain HIPAA Compliance: The Health Insurance Portability and Accountability Act (HIPAA) sets strict guidelines for safeguarding patient health information. These actions can lead to financial losses for patients and payers.

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Compliance Informed Consent HIPAA Medical Billing 52

MedTrainer

OCTOBER 16, 2023

Health Insurance Portability and Accountability Act (HIPAA) HIPAA is a pivotal regulation that focuses on the protection of patient health information, enforced by the U.S. Anti-Kickback Statute The Office of Inspector General (OIG) is responsible for the enforcement of the Anti-Kickback Statute. million annually.

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Compliance US Department of Health and Human Services HIPAA Medicaid 52

MedTrainer

FEBRUARY 12, 2024

Legal Penalties: Healthcare non-compliance can result in legal penalties, including fines, civil lawsuits, or criminal charges, depending on the severity of the violation. For example, healthcare fraud or intentional non-compliance with regulations can lead to criminal charges.

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Compliance Licensing Governance Fraud 52

MedTrainer

AUGUST 30, 2023

Medicaid Managed Care. Some state Medicaid programs contract with managed care organizations to provide healthcare services to eligible beneficiaries. These plans follow managed care principles to control costs and improve care coordination for Medicaid recipients. Quality of Care Standards. Data Security and Privacy.

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Compliance Regulatory Compliance Medicaid Medicaid 52

MedTrainer

NOVEMBER 15, 2023

It conducts audits, investigations, and evaluations to ensure efficiency and integrity in HHS programs, including Medicare and Medicaid. The OIG also enforces standards for healthcare providers and suppliers to prevent fraud and imposes penalties for non-compliance. Designate a compliance officer and/or compliance committee.

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Compliance Framework Governance Compliance Medicaid 52

MedTrainer

AUGUST 2, 2023

They review healthcare claims and billing practices to ensure accuracy, detect fraud or abuse, and assess compliance with the payer’s policies and guidelines. Federal Government Audits These audits are performed by government agencies such as the Centers for Medicare and Medicaid Services (CMS).

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Compliance ACA Medicaid Medicaid 52

AIHC

FEBRUARY 16, 2024

The OIG states the following: “Entities also should develop appropriate incentives to encourage participation in the entity’s compliance program.” “The I am a Certified Internal Healthcare Fraud Auditor (CIFHA). Within item #5 are directives from the OIG related to incentives. First, we need to look at exactly what happened.

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Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

The OIG states the following: “Entities also should develop appropriate incentives to encourage participation in the entity’s compliance program.” “The I am a Certified Internal Healthcare Fraud Auditor (CIFHA). Within item #5 are directives from the OIG related to incentives. First, we need to look at exactly what happened.

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

Hall Render

DECEMBER 29, 2023

Here’s a look at how 11 area hospitals ranked Kentucky’s registered nurse median salary ranks 38th in U.S. bill would allow IVF therapy for same-sex veteran marriages; VA denies coverage Cancer-killing gel, minimally-invasive brain shunts: Here are recent startups spun out of area hospitals UMass Memorial named one of top U.S.

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Nursing Homes US Department of Health and Human Services Nurses COVID-19 40