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

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

APRIL 27, 2022

As more healthcare professionals obtain licensure under compacts, compliance officers need to be aware of interstate licensure requirements – and their effects on patient care. The compact enables nurses to provide nursing services to patients located in other NLC states via telehealth without obtaining additional licenses.

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Compliance Officers Licensing Compliance Nurses 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

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

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

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

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

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 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

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

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

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

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 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

DECEMBER 4, 2023

The Division of Medicaid and Long-Term Care within DHHS is responsible for administering Medicaid services and overseeing long-term care programs, ensuring accessible and quality healthcare for vulnerable populations in Nebraska. Providers must complete three hours of continuing education (CE) in opiate prescribing, with.5

Compliance 52

Compliance Licensing Nursing Homes Nurses 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 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

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 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

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

JANUARY 12, 2024

Here are some of the key organizations involved in regulating healthcare compliance: Centers for Medicare & Medicaid Services (CMS): CMS is a federal agency within the U.S. Department of Health and Human Services responsible for administering and regulating healthcare programs such as Medicare and Medicaid.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

MedTrainer

NOVEMBER 20, 2023

The TSBEPC ensures practitioners adhere to licensing requirements and maintain high standards of competence and ethical practice. The Texas HHS oversees regulations for Medicare- and state Medicaid-funded services.

Compliance 52

Compliance Licensing Public Health Governance 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.

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Electronic Medical Records Licensing Medicare Medicare 52

MedTrainer

DECEMBER 4, 2023

The Mississippi Division of Medicaid administers health coverage programs to eligible residents, providing vital healthcare services to underserved and vulnerable populations in the state. These agencies help maintain the integrity and quality of healthcare services in Mississippi , protecting the public and promoting patient safety.

Compliance 52

Compliance Telemedicine Licensing Public Health 52

MedTrainer

NOVEMBER 29, 2023

TennCare is Tennessee’s managed Medicaid agency. It administers and oversees the state’s Medicaid programs, providing essential healthcare services to low-income individuals and families in Tennessee. These features collectively enhance the efficiency, accessibility, and rigor of the medical credentialing process in Tennessee.

Compliance 52

Compliance Licensing HIPAA Medicaid 52

MedTrainer

NOVEMBER 17, 2023

It has various departments, including the Office of Compliance, which is committed to ethics, integrity, and compliance with regulations, laws, and policies. The Pennsylvania State Board of Medicine is responsible for regulating medical provider licensing requirements.

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Compliance Licensing Health Outcomes Medicaid 52

MedTrainer

NOVEMBER 30, 2023

Minnesota’s Medical Assistance (MA) under the state’s Department of Human Services (DHS) is the state’s Medicaid program that provides health care coverage to low-income individuals and families, including children, pregnant women, seniors, and people with disabilities.

Compliance 52

Compliance Licensing Public Health Governance 52

MedTrainer

NOVEMBER 29, 2023

The Indiana Family and Social Services Administration (FSSA) is a state’s Medicaid agency that provides essential support and services, such as healthcare, mental health, and social services, to improve the welfare and quality of life for families and individuals in Indiana.

Compliance 52

Compliance Licensing Governance Public Health 52

MedTrainer

SEPTEMBER 21, 2023

For healthcare facilities, ensuring compliance with regulations and maintaining high standards of patient care is of the utmost importance. One crucial aspect of this is knowing how to prepare for a CMS inspection by the Centers for Medicare & Medicaid Services. Exclusions.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

NOVEMBER 14, 2023

In Virginia, healthcare compliance may differ in Medicaid policies, telehealth regulations, scope of practice for healthcare professionals, certificate of need (CON) laws, and specific state mandates related to healthcare reporting and licensing.

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Compliance Licensing Governance Hospitals 52