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. To become certified, please visit us at: American Medical Compliance (AMC).

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Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

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Provider Trust

MARCH 13, 2023

On January 25, 2023, the US Department of Justice joined with the Federal Bureau of Investigation (FBI) and the US Department of Health and Human Services Office of Inspector General (HHS-OIG) to launch a multi-state law enforcement action to apprehend individuals involved in this fraudulent nursing degree scheme.

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

Healthcare Law Blog

FEBRUARY 9, 2024

million to resolve a lawsuit filed by the system’s former Chief Compliance Officer, Ronald Sherman. Sherman alleged that these “in-kind” services constituted improper remuneration that was intended to induce the physicians to make referrals to ChristianaCare. ChristianaCare did not admit liability as part of the settlement.

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Hospitals Compliance Officers Compliance Overpayments 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. An example is knowingly billing for services a doctor hasn’t provided.

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Medicare Medicare Compliance Compliance Officers 52

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. Generally, compliance officers ensure that OIG internal monitoring and auditing.

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Compliance Officers Compliance Medicare Medicare 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.

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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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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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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. On November 6, 2023, the Office of Inspector General (OIG) of the U.S.

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

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

Healthcare Law Blog

NOVEMBER 9, 2023

In late April this year, the Office of Inspector General, Department of Health and Human Services (OIG) announced that it would make changes to its existing body of healthcare compliance program guidance (CPGs) as part of its current Modernization Initiative. [1]

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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. They note the best way to identify risks is to follow the money.

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YouCompli

MAY 11, 2022

They offer clues for compliance professionals to spot training opportunities before they become enforcement actions. Billing for services not needed or received. She had billed for services that were either unnecessary or were not provided. The doctor will be sentenced in July for multiple counts of healthcare fraud.

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Compliance Officers Fraud Compliance Medicare 52

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.

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Fraud 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.

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Fraud Compliance Officers Compliance 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. But what exactly is considered fraud, waste, and abuse? Risk Assessment. Legislation and Congressional Requests.

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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. The DOJ Announcement stresses the importance of investing in strong compliance programs for both the buyers and sellers in business transactions.

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Compliance Due Diligence Fraud Governance 52

YouCompli

DECEMBER 19, 2023

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.” Effective communication and collaboration between compliance and legal is the key to a successful outcome.

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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

FEBRUARY 1, 2024

These red flags are used to identify situations or activities that may raise concerns about fraud, waste, abuse, or non-compliance with healthcare regulations. Appoint a compliance officer or team responsible for overseeing compliance efforts. Ensure that documentation reflects the services provided accurately.

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Compliance Compliance Officers Fraud HIPAA 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. Office for Civil Rights (OCR) : Provides oversight of the safe and ethical handling of patient data and privacy. The post What Is Healthcare Compliance?

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Health Law Advisor

AUGUST 25, 2023

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. New York Social Services Law § 363-d. New Self-Disclosure Program rules (amendments to N.Y.

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Compliance Overpayments Overpayment Compliance Officers 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

Healthcare Law Today

FEBRUARY 3, 2023

The Vision and Realities of Telehealth Adoption , ” examining the new reality for patients and providers alike that want access to telehealth services for a range of healthcare interactions. This year’s conference will explore the theme “ From Now What? ATA 2023: Join Us for Live Music and Libations!

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Telemedicine Fraud Compliance Officers Compliance 83

Hall Render

NOVEMBER 10, 2023

On November 6, 2023, the Office of Inspector General (“OIG”) for the U.S. Department of Health and Human Services (“HHS”) issued new General Compliance Program Guidance (“GCPG”) for members of the health care compliance community and other health care stakeholders.

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Compliance Compliance Officers Fraud Governance 40

C&M Health Law

DECEMBER 18, 2023

The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) published the General Compliance Program Guidance (GCPG) on November 6, 2023. The GCPG provides updated descriptions of the seven elements of an effective compliance program that health care entities have long relied upon.

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Compliance Compliance Officers Governance Overpayments 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

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Fraud Governance Compliance Medicare 59

Healthcare Blog

NOVEMBER 9, 2023

Healthcare organizations should clearly define their expectations and the consequences for non-compliance. A strong compliance program assists organizations in navigating this complicated landscape while avoiding potential breaches and penalties. These documents should serve as a roadmap for employees. Organizations such as the U.S.

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Healthicity

JANUARY 23, 2024

The Health and Human Services Office of Inspector General (OIG) recently published General Compliance Program Guidance 1 , and one of the many important sections in the document includes a list of a compliance officer’s primary responsibilities.

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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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Compliance Fraud Regulatory Compliance Regulations Compliance 52

Healthcare Compliance Blog

APRIL 26, 2022

The Office of Inspector General (OIG) for the US Department of Health and Human Services (HHS) has made educational resources available for healthcare providers to comply with federal healthcare laws and regulations. Voluntary Compliance: OIG has several self-disclosure processes to report fraud in HHS programs.

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US Department of Health and Human Services Fraud Compliance Medicaid 59

Compliancy Group

FEBRUARY 29, 2024

The Office of Inspector General (OIG) facilitates the development of the Corporate Integrity Agreement between the U.S. Department of Health and Human Services (HHS) OIG and the organization. Many companies provide IRO services, including reviews of claims, compliance measures, vetting new hires, and transactions.

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Compliance Compliance Officers Overpayments Overpayment 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. or Contact Us .

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Medicare Medicare Compliance Officers Fraud 52

MedTrainer

NOVEMBER 14, 2023

Certified Professional Compliance Officer (CPCO) : Provided by the American Academy of Professional Coders, the CPCO certification is designed for leaders in compliance program management and addresses various healthcare regulations, including those related to fraud prevention and ethical medical coding.

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Compliance Compliance Officers HIPAA Governance 52

MedTrainer

FEBRUARY 12, 2024

In this blog, we’ll share how healthcare organizations are managing compliance around false claims and safeguarding both the integrity of healthcare services and the welfare of patients. We’ll also highlight tools to streamline compliance processes and reduce the risk of potential legal and financial judgments.

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Compliance Fraud Medicaid Medicaid 52

YouCompli

DECEMBER 7, 2022

Department of Health and Human Services Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded healthcare programs. These exclusions are generally related to criminal activity like fraud or healthcare-related misconduct. Provision of unnecessary or substandard services.

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