Compliancy Group

JUNE 6, 2024

More specifically, this federal statute makes it illegal for providers to refer Medicare patients for any treatment services with which that provider has a financial relationship or interest. Legal Consequences for Violating Stark Laws in Healthcare The Office of Inspector General (OIG), through the U.S.

Compliance Officers 59

Compliance Officers Compliance US Department of Health and Human Services Medicare 59

MedTrainer

APRIL 11, 2024

There is one way to describe the relationship between HR professionals and compliance officers: It’s complicated. As you see these roles work together, you might wonder about the difference between a compliance officer and human resources in healthcare.

Compliance Officers 52

Compliance Officers Compliance Medicaid Medicaid 52

American Medical Compliance

OCTOBER 25, 2024

The healthcare industry is highly regulated, with various laws such as the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health Act (HITECH), and the Medicare and Medicaid Services (CMS) regulations shaping operations.

Compliance 105

Compliance Fraud Compliance Framework HIPAA 105

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

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

OCTOBER 4, 2024

For example, internal audits help compliance officers and executives maintain operational efficiency, reduce errors, improve workflows, and enhance the bottom line. An internal audit is an excellent opportunity to detect factors contributing to non-compliance, mitigate risk, and address potential problems.

Compliance Officers 59

Compliance Officers Compliance Regulatory Compliance Fraud 59

MRO Compliance

AUGUST 3, 2022

Consider auditing software that can instantly transmit charts, discussions, and appeal filings to Medicare, Medicaid and commercial auditors, preventing file loss and delivery delay. If errors are found, the internal compliance officer can determine if repayment in accordance with the 60-day rule is appropriate.

Compliance Officers 130

Compliance Officers Medicare Medicare Compliance 130

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

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.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

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

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.

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

Verisys

MARCH 6, 2025

Healthcare executives and compliance officers must consistently update and verify provider data to enhance patient care, adhere to regulatory standards, and streamline administrative tasks. Similarly, insurance companies that process thousands of claims daily require up-to-date provider information to avoid claims delays and denials.

Compliance 52

Compliance Licensing Doctors Malpractice 52

Verisys

MARCH 6, 2025

Healthcare administrators and compliance officers must be prepared to navigate these obstacles to maintain a seamless, efficient process. This process helps guarantee that providers stay in line with state and federal regulations, keeping healthcare organizations in good standing with insurers, regulators, and other key players.

Licensing 52

Licensing Compliance Nurses Malpractice 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 collaborates with other law enforcement agencies.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

Verisys

APRIL 3, 2025

Exclusions from Medicare and Medicaid Instances where a provider has been banned from participating in government-funded healthcare programs. Medicare and Medicaid Compliance Requirements , which mandate reporting of program exclusions. This is where Verisys healthcare provider credentialing solutions come in.

Malpractice 52

Malpractice Licensing Compliance Hospitals 52

Compliancy Group

JULY 8, 2024

That’s why it’s essential to understand and apply the Center for Medicare and Medicaid (CMS) Rule for Emergency Preparedness. Each organization must comply with the CMS Emergency Preparedness Rule to participate in Medicare and Medicaid. To this end, your CMS emergency preparedness plan should contain these components.

Compliance Officers 52

Compliance Officers Compliance Medicaid Medicaid 52

Healthicity

APRIL 24, 2025

Whether its Medicare, Medicaid, or a commercial payer, understanding how to respond is key to protecting your organization. No healthcare provider wants to receive a third-party audit noticebut many will.

Medicaid 59

Medicaid Medicaid Medicare 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. Findings from OIG audits can identify compliance areas needing improvement.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

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?

Compliance 52

Compliance Compliance Officers Health Insurance 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

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

Compliance Officers 52

Compliance Officers Compliance Telemedicine COVID-19 52

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).

Compliance 52

Compliance Compliance Officers Fraud Medicaid 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.

US Department of Health and Human Services 52

US Department of Health and Human Services Compliance Officers Fraud 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. Fraudulent documentation was submitted in response to Medicare audits. That is how you collect $4.1 L earn more.

Fraud 52

Fraud Compliance Medicaid Medicaid 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.

Fraud 52

Fraud Compliance Medicare Medicare 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

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

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.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Medicaid 59

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.

Compliance Officers 52

Compliance Officers Licensing Nurses Compliance 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

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

JULY 29, 2024

Corporate compliance training software is vital to tailoring programs to staff, departments, and locations. Corporate compliance training software helps healthcare executives and compliance officers mitigate legal and financial risks while fostering a culture of ethical behavior. monitorship or reporting obligations).”

Compliance 52

Compliance US Department of Health and Human Services Regulatory Compliance Compliance Officers 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

AUGUST 30, 2023

Medicare Advantage (Part C). Medicare Advantage plans are managed care plans offered by private insurance companies as an alternative to traditional Medicare (Parts A and B). Medicaid Managed Care. These plans follow managed care principles to control costs and improve care coordination for Medicaid recipients.

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

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.

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 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.

Compliance 52

Compliance Fraud Compliance Officers HIPAA 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.

Fraud 52

Fraud Medicaid Medicaid Licensing 52