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

MAY 26, 2023

Thursday, June 22, 2023 | 12-1pm CST Join us for an information session where Donna Thiel, Chief Compliance Officer at ProviderTrust, will share her expertise and valuable feedback from the 2023 HCCA Compliance Institute.

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MedTrainer

FEBRUARY 7, 2024

The complex world of healthcare compliance demands a clear understanding of responsibilities. For those new to the role of compliance officer, the question often arises: “Who is responsible for compliance in healthcare?” Who is Responsible for Compliance in Healthcare?

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MedTrainer

JANUARY 30, 2024

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). Certified Compliance and Ethics Professional (CCEP) offered by the Compliance Certification Board (CCB).

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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

YouCompli

SEPTEMBER 13, 2023

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. In addition, CMS education and outreach focuses on preventing, detecting, and reporting Medicare fraud and abuse.

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

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.

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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.

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Compliancy Group

FEBRUARY 29, 2024

When a hospital, doctor’s office, or other healthcare organization is guilty of a regulatory or compliance violation , the U.S. Office of Inspector General (OIG) can invoke civil or criminal prosecution or licensure or other penalties, fines, exclusions from federal programs like Medicare, or revocation of billing privileges.

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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. “Not

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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.

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Fraud Compliance Officers Compliance Medicare 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.

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Compliance Compliance Officers Licensing Medicaid 52

MedTrainer

JANUARY 10, 2024

Centers for Medicare and Medicaid Services (CMS) requires nursing homes and ambulatory surgery centers (ASCs) to have an individual who is qualified by experience and training to serve as an infection control preventionist. Evaluate your current infection control and prevention plan.

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Compliance Fraud HIPAA Compliance Officers 94

MedTrainer

APRIL 22, 2024

A healthcare compliance committee is a cross-functional team that monitors compliance at a strategic level. An influential healthcare compliance committee supports the compliance officer in promoting ethical practices, mitigating risks, and advising on compliance program operations.

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Compliance Compliance Officers Governance 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?

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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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YouCompli

APRIL 5, 2023

The seven elements in the OIG’s effective compliance program are also useful as we consider how to best deliver quality patient care post-PHE. Each element is an opportunity for compliance officers to position their organization to provide the best patient care. Be sure to implement ongoing staff education programs.

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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 collaborates with other law enforcement agencies.

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Fraud Compliance Medicaid Medicaid 98

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.

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Medicare Medicare Compliance Officers Fraud 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. And healthcare compliance officers have processes and procedures to update. Compliance considerations.

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MedTrainer

MARCH 8, 2024

These financial incentives are from agencies such as the Centers for Medicare and Medicaid Services (CMS) and the Health Resource & Services Administration (HRSA) , who are working to achieve health equity and improve public health. FQHCs can participate in APMs through Medicare and Medicaid Managed Care Organizations (MCOs).

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Med-Net Compliance

OCTOBER 19, 2022

The settlement resolves allegations that between 2013 and 2020, the company paid remuneration to its home health medical directors in Oklahoma and Texas for the purpose of inducing referrals of Medicare and TRICARE home health patients. The corporate officers were previously the CEO and COO of the company.

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US Department of Health and Human Services Medicare Medicare Medicaid 59

MedTrainer

JUNE 28, 2023

CFEs collaborate with various stakeholders — including compliance officers, legal teams, auditors, and law enforcement agencies — to address fraud and compliance-related issues. The FCA prohibits submitting false or fraudulent claims for payment to government healthcare programs, such as Medicare and Medicaid.

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Fraud Compliance Governance Compliance Officers 52

American Medical Compliance

FEBRUARY 15, 2023

The impact of these losses and risks magnifies as Medicare continues to serve a growing number of beneficiaries. Even organized crime groups infiltrate the Medicare Program and operate as Medicare providers and suppliers. The Centers for Medicare and Medicaid Services (CMS) require FWA training.

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American Medical Compliance

FEBRUARY 15, 2023

The impact of these losses and risks magnifies as Medicare continues to serve a growing number of beneficiaries. Even organized crime groups infiltrate the Medicare Program and operate as Medicare providers and suppliers. The Centers for Medicare and Medicaid Services (CMS) require FWA training.

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Fraud Medicare Medicare Compliance 52

Verisys

MARCH 23, 2023

The Most Common False Claims The FCA primarily combats healthcare fraud and abuse associated with Medicare and Medicaid. Violation of this law requires health services to be payable by Medicare or Medicaid. Notify your supervisor or compliance officer immediately if you become aware of a potential billing problem.

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Verisys

MAY 3, 2023

7 Core Elements of Healthcare Compliance Plan and How to Measure Them Healthcare compliance regulations are complex and ever-changing, but are an essential part of any healthcare organization’s effort to provide safe, high-quality care for patients. Measuring effectiveness: Who is your designated compliance officer?

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Compliance Compliance Officers ADA Governance 52

MedTrainer

MARCH 28, 2024

Law by law, regulations were added, increasing the complexity of maintaining compliance for healthcare organizations. This is one of seven components recommended in the OIG’s compliance guidelines. For all-size organizations, the owner(s)/executive team has a legal and ethical responsibility to maintain compliance.

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Compliance Compliance Officers Licensing 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.

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US Department of Health and Human Services Fraud Compliance Medicaid 59

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.

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Compliance Compliance Officers Licensing Medicaid 52

YouCompli

MARCH 29, 2023

During the PHE, the Centers for Medicare and Medicaid Services (CMS) relied on emergency authorizations, waiver authorities, regulatory processes, and sub-regulatory guidance to create numerous waivers and flexibilities. Finally, note that these issues are specific to Medicare and Medicaid beneficiary patients only.

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Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the new contract year.

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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.

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MedTrainer

FEBRUARY 12, 2024

Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. How are healthcare organizations ensuring compliance and minimizing exposure risks to false claims? government collected $2.2B

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Compliance Fraud Medicaid Medicaid 52

MedTrainer

MAY 21, 2024

With the odds of a person entering your healthcare facility dealing with a behavioral or mental health issue at about 20% , new and existing clinical providers must receive behavioral health compliance training to ensure patients receive the highest quality care.

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Provider Trust

JUNE 15, 2022

The OIG alleged that Summa employed an individual on the Ohio Provider Medicaid Exclusion and Suspension List as well as an individual who was excluded from participation in Federal health care programs. In this particular case, the exclusion came from the Ohio Provider Medicaid Exclusion and Suspension List. Donna Thiel.

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Medicaid Medicaid Compliance Compliance Officers 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.

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