AIHC

SEPTEMBER 3, 2024

Celebrating the Healthcare Compliance Officer The American Institute of Healthcare Compliance is recognizing healthcare Compliance Officers – hats off to you! The primary goal of a compliance officer is to mitigate risk. The field has since diversified to fit all kinds of firms and businesses.

Compliance Officers 52

Compliance Officers Compliance Fraud Medicare 52

Verisys

FEBRUARY 23, 2022

As government agencies and national regulatory organizations pass more regulations and the need for healthcare services grows, healthcare compliance officers (HCOs) are more important than ever. Accordingly, maintaining compliance has become a key focus for healthcare facilities. HCO Qualifications. Reimbursement.

Compliance Officers 52

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

Compliancy Group

MARCH 12, 2025

A healthcare organization that does not follow proper methods of obtaining reimbursement from federal payor programs such as Medicare may run afoul of federal fraud, waste, and abuse laws. To avoid running afoul of potential civil or criminal liability, organizations must ensure that Medicare claim reporting is accurate.

Fraud 52

Fraud Compliance Medicare Medicare 52

MedTrainer

NOVEMBER 2, 2023

This critical responsibility rests on the shoulders of the healthcare compliance officer. Read on if you’ve ever wondered about the unsung heroes as we answer the question: What does a compliance officer do in healthcare? What Is the Primary Role of a Compliance Officer in Healthcare?

Compliance Officers 52

Compliance Officers Compliance HIPAA Regulatory Compliance 52

Compliancy Group

OCTOBER 4, 2024

Despite your best efforts in meeting healthcare compliance requirements, errors may still occur. Maintaining the security and integrity of sensitive information and preventing waste, fraud, and abuse is essential to quality healthcare and promoting workplace safety.

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Compliance Officers Compliance Regulatory Compliance Fraud 59

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.

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Compliance Compliance Officers Fraud HIPAA 111

Health Law RX

NOVEMBER 22, 2023

The GCPG has been anticipated since the OIG announced on April 25, 2023, that it planned to modernize the accessibility and usability of its publicly available resources, including the OIG’s Compliance Program Guidance (CPG) documents. The OIG anticipates addressing Medicare Advantage and nursing facilities next.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

Compliancy Group

MARCH 22, 2024

depend on Medicare to get the healthcare they need. Remaining in good standing with Medicare has several advantages. Compliance Program A comprehensive way to avoid Medicare exclusion is to develop an organization-wide compliance program, one of the Centers for Medicare and Medicaid Services (CMS) requirements.

Medicare 52

Medicare Medicare Compliance Compliance Officers 52

Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 billion from settlements due to fraud and false claims. As a healthcare provider, being familiar with healthcare fraud and abuse laws is important. government or a government contractor.

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MedTrainer

JUNE 28, 2023

In healthcare especially, fraud is something responsible providers need to be on the lookout for. It’s why many organizations choose to work with a Certified Fraud Examiner as part of their ongoing efforts to remain responsible and compliant with financial best practices. What is a Certified Fraud Examiner?

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Fraud Compliance Governance Compliance Officers 52

American Medical Compliance

FEBRUARY 15, 2023

The Dental Healthcare 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. The Centers for Medicare and Medicaid Services (CMS) require FWA training.

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Fraud Medicare Medicare Compliance 52

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

Health Care Performance

JULY 20, 2022

A New York ENT physician was convicted of filing false claims with Medicare and Medicaid. The physician submitted claims totaling about $585,000 to Medicare and Medicaid and was paid roughly $191,000. Mole billing fraud scheme totals $4.1 Fraudulent documentation was submitted in response to Medicare audits.

Fraud 52

Fraud Compliance 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

AIHC

SEPTEMBER 25, 2024

Reviewing the Office of Inspector General's (OIG) enforcement actions is important for compliance officers because it can help them understand the OIG's focus and priorities, and how to comply with federal health care laws and regulations. Government agencies expect your organization to stay informed.

Fraud 52

Fraud Compliance Compliance Officers Licensing 52

YouCompli

MAY 11, 2022

They offer clues for compliance professionals to spot training opportunities before they become enforcement actions. In March of 2022, a New Jersey rheumatologist was convicted by a federal jury for defrauding Medicare and other health insurance programs. The doctor will be sentenced in July for multiple counts of healthcare fraud.

Compliance Officers 52

Compliance Officers Fraud Compliance Medicare 52

Healthcare Compliance Blog

FEBRUARY 15, 2022

billion in settlements and judgments have been recovered by the Department of Justice Department (DOJ) related to civil cases involving fraud and false claims in fiscal year 2021. The government paid $237 million in fiscal year 2021 to whistleblowers who exposed fraud and false claims. More than $5.6

Fraud 59

Fraud Governance Compliance Medicare 59

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Medicare Advantage (M.A.): and cybersecurity threats. Organizations using M.A.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 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

OCTOBER 1, 2024

Compliance officers and other organizational leaders must be constantly vigilant of resource waste and the inappropriate and illegal use of funds from Medicare and other federal programs. Compliance with Medicare and other programs requires relevant staff to take regular fraud, waste, and abuse (FWA) training.

Fraud 52

Fraud Compliance Medicare Medicare 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

US Department of Health and Human Services 52

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

Compliancy Group

OCTOBER 16, 2024

There’s a significant connection between healthcare compliance and risk management. Compliance officers must thoroughly understand both concepts to protect their organizations and the patients they serve. Risk management refers to identifying, avoiding, and mitigating the factors contributing to healthcare non-compliance.

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Compliance Compliance Officers Fraud Regulatory Compliance 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. Toolkits: The OIG has created several toolkits to help providers ensure they are in compliance with healthcare laws.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Compliance Medicaid 59

MedTrainer

SEPTEMBER 20, 2023

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. There are several accrediting organizations that require facilities to meet or exceed Medicaid and Medicare guidelines. Accreditation.

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Medicaid Medicaid Medicare Medicare 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].

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Compliance Compliance Officers Fraud Medicare 52

Healthcare Compliance Blog

APRIL 13, 2022

The two men, both 51, were convicted of criminal healthcare fraud and conspiracy charges in 2019. On April 7, 2022, a civil complaint was filed against the two men, which alleges that they conspired to violate the False Claims Act by submitting false and fraudulent claims to Medicare for medically unnecessary hospice and home health services.

Fraud 59

Fraud Medicare Medicare Compliance 59

Compliancy Group

FEBRUARY 7, 2024

This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.

Fraud 52

Fraud Compliance Medicare Medicare 52

Verisys

APRIL 3, 2025

Exclusions from Medicare and Medicaid Instances where a provider has been banned from participating in government-funded healthcare programs. Criminal convictions related to healthcare Felonies or misdemeanors involving fraud, patient abuse, or drug-related offenses.

Malpractice 52

Malpractice Licensing Compliance Hospitals 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

JUNE 21, 2024

The Office of the Inspector General (OIG) has honed in on chiropractic practices over the last few years because of improper payments and claims, and noncompliance with Medicare requirements. There seems to be a gap between chiropractic services and positive compliance outcomes.

Compliance 52

Compliance Compliance Officers Medicare Medicare 52

Innovaare Compliance

AUGUST 31, 2022

Medicare Advantage Organizations (MAOs) are private health plans that contract with the Centers for Medicare & Medicaid Services (CMS) to provide a menu of health care services similar to those offered under Original Medicare. 1 They pay for the services with monthly fixed payments (capitation) from CMS.

Medicare 52

Medicare Medicare Compliance Officers Fraud 52

Compliancy Group

SEPTEMBER 16, 2024

In November, updates for 2024 appeared in the OIG General Compliance Program Guidance, including recommendations for Medicare, nursing facilities, and other industry-specific entities. Compliance officers have access to more information about their responsibilities and roles.

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Compliance Compliance Officers Fraud Electronic Medical Records 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. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back.

Fraud 52

Fraud Medicare Medicare Compliance 52

Compliancy Group

AUGUST 30, 2024

Staff training : Topics including employee rights and responsibilities in handling PHI, core policy practices, best practices in ethical behavior, the importance of HIPAA compliance, and identifying and reporting incidents. Under the direction of the U.S.

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Compliance Fraud Compliance Officers HIPAA 52

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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Compliance Compliance Officers Fraud Compliance Framework 52

HIPAA Journal

JANUARY 30, 2023

Government Keynote Speakers Nicholas Heesters, MEng, JD, CIPP – Senior Advisor for Cybersecurity, Office for Civil Rights, US Department of Health and Human Services, Philadelphia, PA Melanie Fontes Rainer, MSME, JD – Director, Office for Civil Rights, HHS; Former Senior Advisor, Healthcare to Attorney General, CA DOJ; Former Chief of Staff, (..)

US Department of Health and Human Services 83

US Department of Health and Human Services HIPAA Compliance Medicaid 83

Compliancy Group

OCTOBER 25, 2024

If your healthcare organization relies on Medicare and other federal benefits, your worst fear may be ending up on the system for award management exclusion list. A non-compliance incident on your record can bar you from federal funds that enable you to provide essential medical care.

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Compliance Medicare Medicare Fraud 52