MedTrainer

JANUARY 10, 2024

Review Recent Compliance Changes There is a major shift in compliance priorities toward addressing health inequities and improving access to quality healthcare services. The OIG is making major investments to systematically detect and prosecute fraud. We all should be a LOT more prepared!

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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).

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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].

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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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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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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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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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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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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?

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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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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

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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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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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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MedTrainer

APRIL 8, 2024

These requirements include but are not limited to: Health Insurance Portability and Accountability Act (HIPAA): Protects the privacy and security of patients’ health information. Medicare Access and CHIP Reauthorization Act (MACRA): Promotes value-based care and rewards healthcare providers for quality and performance.

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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 role of Compliance Officer for an association with 200 doctors had its challenges. My task was to educate providers and staff through seminars on rules and regulations with Medicare.

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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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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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MedTrainer

AUGUST 30, 2023

Medicare Advantage (Part C). Medicare Advantage plans are managed care plans offered by private insurance companies as an alternative to traditional Medicare (Parts A and B). Some key compliance elements for managed care organizations include: Legal and Regulatory Compliance. Quality of Care Standards.

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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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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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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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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

Hall Render

DECEMBER 29, 2023

NATIONAL 4 largest healthcare data breaches of 2023 Anesthesia practices sue CMS over reimbursement method Antitrust enforcements hit a high in 2022, with health deals impacted ASCs face leadership exodus CMS floats appeals process over observational stays CMS proposes additional Medicare appeals processes FTC eyes healthcare mergers, report shows (..)

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