Compliance Officers Medicaid Medicare Overpayments 
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.
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
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.
Compliancy Group
FEBRUARY 2, 2024
In the case of healthcare fraud or other forms of noncompliance, the organization at fault could enter a corporate integrity agreement (CIA) with the Office of the Inspector General (OIG).
YouCompli
FEBRUARY 22, 2023
Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS). This means reimbursement is not typically based on charges.
AIHC
APRIL 5, 2022
If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back. A great free modifier resource to share with you is the CMS Medicare Administrative Contractor (MAC) “WPS” learning center with on-demand training materials. If in doubt, check it out.
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