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

JUNE 29, 2022

With it, compliance officers have guided their healthcare organizations in complying with changing documentation, coding, and confidentiality requirements. As virtual care requirements for telehealth evolve, we explore how compliance officers can support patient care and help their organizations stay up to date.

Compliance Officers 52

Compliance Officers Compliance Telemedicine COVID-19 52

MedTrainer

DECEMBER 7, 2023

All healthcare organizations, along with their providers and compliance officers, must understand the requirements of each regulatory state agency that provides oversight. The Med-QUEST Division administers Hawaii’s Medicaid program, providing essential healthcare services to low-income individuals and families across the state.

Compliance 52

Compliance Compliance Officers Licensing Medicaid 52

MedTrainer

DECEMBER 4, 2023

The Kentucky Cabinet for Health and Family Services (CHFS), Department for Medicaid Services administers the state’s Medicaid program, ensuring access to essential health care services for eligible low-income individuals and families in Kentucky.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

DECEMBER 7, 2023

The Medicaid and Health program of Idaho provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities in the state, offering a range of medical and health-related services. The IMLC streamlines physician licensure for multi-state practice, including telehealth.

Compliance 52

Compliance Licensing Compliance Officers Informed Consent 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. Magazine, and the Nashville Business Journal.

Fraud 52

Fraud Medicaid Medicaid Licensing 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. Magazine, and the Nashville Business Journal.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

MedTrainer

NOVEMBER 27, 2023

Managing healthcare compliance in Ohio presents a unique set of challenges for compliance officers, healthcare professionals, and administrators. Organizations need to successfully navigate the regulatory landscape in order to provide efficient and ethical healthcare services, and to avoid consequences for non-compliance.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

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.

Compliance 52

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).

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

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. Register for online training to certify in various areas of compliance.

Fraud 52

Fraud Compliance Compliance Officers Licensing 52

MedTrainer

DECEMBER 7, 2023

MaineCare , operating under the Maine Department of Health and Human Services (DHHS), is the state’s Medicaid program, providing essential health coverage to eligible low-income residents, thereby enhancing access to quality healthcare services in Maine.

Compliance 52

Compliance Licensing Compliance Officers Medicaid 52

HIPAA Journal

NOVEMBER 17, 2022

My first professional experience in healthcare was as a licensed social worker in an acute care hospital. I’m currently on contract to a State Medicaid Agency’s Privacy Office. I perform most of those duties performed in any healthcare privacy compliance office. It’s truly amazing.

Governance 109

Governance HIPAA Compliance Nursing Homes 109

MedTrainer

NOVEMBER 28, 2023

Healthcare providers, organizations, and compliance officers in Michigan State need to be aware of their state-specific laws and regulations in order to navigate compliance successfully. This rigorous procedure not only maintains high-quality healthcare standards but also protects public health and safety.

Compliance 52

Compliance Licensing Public Health Compliance Officers 52

AIHC

MAY 31, 2022

When the federal government covers items or services rendered to Medicare and Medicaid beneficiaries, the federal fraud and abuse laws apply. Government programs, such as the Centers for Medicare & Medicaid Services (CMS), find the investment in their audit and monitoring programs are effective.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

MedTrainer

NOVEMBER 27, 2023

The Division of Health Benefits administers the state’s Medicaid program, which provides essential healthcare coverage to eligible individuals and families. Providers must be licensed in North Carolina, except under certain conditions, and must ensure that services align with their scope of practice. Medicaid expansion under H.B.

Compliance 52

Compliance Licensing Telemedicine Medicaid 52

MedTrainer

NOVEMBER 27, 2023

Through its various departments, such as the Office of Compliance, DPH ensures adherence to ethical standards, regulations, and policies to maintain quality care. The Medical Assistance Plans Division oversees Georgia’s Medicaid and PeachCare for Kids® programs. Operating a pain management clinic without a license is a felony.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

NOVEMBER 29, 2023

The South Carolina Department of Health and Human Services (SCDHHS) administers the state’s Medicaid program and works to enhance the health and well-being of South Carolinians through a range of healthcare services and initiatives. which further ensures that they meet state-mandated health and safety standards.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

NOVEMBER 29, 2023

The Louisiana Department of Health (LDH) Medicaid Program administers the state’s Medicaid services, providing essential health coverage to qualifying residents, including low-income individuals, families, and seniors.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Provider Trust

JULY 25, 2022

Continuous compliance begins with automated monitoring, cross-departmental communication, and population-specific workflow. In a recent webinar , ProviderTrust Founder Michael Rosen and Chief Compliance Officer Donna Thiel detailed ways in which your organization can effectively monitor your unique provider populations.

Electronic Medical Records 52

Electronic Medical Records Licensing Medicare Medicare 52

Verisys

JANUARY 19, 2022

According to recent surveys of major metropolitan hospitals , departments that typically share the responsibility for credentialing include: The Compliance Office. Checks credentialing for Health Insurance Portability and Accountability Act (HIPAA) compliance. Human Resources. Medical Staffing Services. Occupational Health.

US Department of Health and Human Services 52

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

MedTrainer

MARCH 28, 2024

Healthcare Compliance Complexities The first healthcare compliance programs began in the early 20th century as a response to concerns about the quality of care provided by medical practitioners. Licensing and credentialing were introduced to regulate healthcare professionals and ensure minimum standards of care.

Compliance 52

Compliance Compliance Officers Licensing Regulatory Compliance 52

MedTrainer

NOVEMBER 30, 2023

Wisconsin Medicaid is a state-administered program offering comprehensive healthcare coverage to eligible low-income residents, playing a crucial role in ensuring access to essential medical and health services in the state. Also, physicians must renew their credentials every odd year on October 31.

Compliance 52

Compliance Medicaid Medicaid Licensing 52

MedTrainer

DECEMBER 7, 2023

The Medical Assistance Division (MAD) within the New Mexico Human Services Department (HSD) administers the state’s Medicaid program, providing essential healthcare services and financial assistance to eligible low-income residents and families in New Mexico.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

NOVEMBER 28, 2023

The State of New Jersey Department of Human Services, Division of Medical Assistance and Health Services oversees the state’s Medicaid enrollments and programming. The New Jersey Division of Consumer Affairs comprises an array of boards for all licenses , ranging from medical and behavioral/mental health to pharmacy and veterinary.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

NOVEMBER 20, 2023

Ensuring adherence to licensing requirements, the Florida Agency for Health Care Administration oversees Medicaid, coordinating essential healthcare access to vulnerable populations. The Florida Board of Medicine is responsible for regulating practitioner licenses and provides the guidelines providers must adhere to.

Compliance 52

Compliance Licensing Regulatory Compliance Medicaid 52

MedTrainer

JULY 11, 2024

When regulations shift, the primary responsibility for adjusting falls on the shoulders of the organization’s compliance officer and their teams. Harness collective wisdom to strengthen compliance efforts and ensure readiness in healthcare practices.

Regulatory Compliance 52

Regulatory Compliance Compliance Compliance Officers Hospitals 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

MedTrainer

DECEMBER 7, 2023

The New Hampshire Medicaid (Medical Assistance) program within DHHS provides medical assistance to eligible low-income residents, offering a range of healthcare services to support their health and well-being. Conveniently, license renewals are also completed online through the OPLC website.

Compliance 52

Compliance Licensing Public Health Medicaid 52

MedTrainer

NOVEMBER 30, 2023

The Missouri Department of Social Services (DSS) is the state agency responsible for providing essential support and services to vulnerable individuals and families, including child welfare, assistance programs, and oversees the MO HealthNet Division , which is the state’s Medicaid program.

Compliance 52

Compliance Compliance Officers Hospitals Public Health 52

MedTrainer

NOVEMBER 17, 2023

Managing healthcare compliance in Illinois requires healthcare organizations and professionals to stay informed about state-specific regulations while also adhering to federal healthcare compliance standards. Medical licensing is provided by the Illinois Department of Financial and Professional Regulation.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

NOVEMBER 14, 2023

Compliance officers, human resource leaders, credentialing teams, and administrators are all asking themselves these critical questions. While payments could take longer, so might Medicare/Medicaid enrollments for organizations, providers, and patients. But what does this mean for your healthcare business?

Governance 52

Governance Medicaid Medicaid Medicare 52

MedTrainer

NOVEMBER 30, 2023

To manage healthcare compliance in Alabama successfully, providers and compliance officers need to know the ins-and-outs of state-specific regulations. While tricky to navigate, staying up to date with compliance requirements and standards can make the process more manageable.

Compliance 52

Compliance Compliance Officers Public Health Licensing 52

Provider Trust

JULY 17, 2023

In our recent webinar, ProviderTrust’s Chief Compliance Officer, Donna Thiel, shared her expertise and valuable feedback from the 2023 HCCA Compliance Institute. Watch the Webinar During the Keynote Speech at the HCCA Compliance Institute this year, Office of Inspector General (OIG) Christi A.

Compliance 52

Compliance Nursing Homes Nurses Fraud 52

MedTrainer

FEBRUARY 12, 2024

An investigation for compliance violations may occur long after it occurred ( in some cases years !). Non-compliance can lead to significant fines, legal battles, and the loss of license or accreditation. These actions can include fines, sanctions, or even revocation of licenses or certifications.

Compliance 52

Compliance Licensing Governance Fraud 52

MedTrainer

NOVEMBER 28, 2023

The Arizona Health Care Cost Containment System (AHCCCS) is Arizona’s Medicaid agency, providing health care programs to serve Arizona residents through managed care, cost containment, and services aimed at improving the health of those it covers.

Compliance 52

Compliance Licensing Public Health Medicaid 52

Provider Trust

MAY 9, 2024

But it siloed us and created a lot of duplicative work,” said the organization’s Corporate Compliance Officer. “We grew up doing what had to be done. The laws have come so fast and so furiously. Partnering with ProviderTrust allowed the client to automate their exclusion monitoring and primary source verification processes fully.

Compliance 52

Compliance Compliance Officers Licensing Medicaid 52