YouCompli

MAY 11, 2022

It reflects remarks CJ made at HCCA’s 2022 Compliance Institute. For more insights from the Compliance Institute, download our white paper on how compliance professionals can help healthcare institutions mitigate risk.). The doctor will be sentenced in July for multiple counts of healthcare fraud.

Compliance Officers 52

Compliance Officers Fraud Compliance Medicare 52

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. 405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. Parts 417, 422, 423, 455, and 460.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. Additionally, check out this HHS-OIG 2016 report, Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure , which revealed “vulnerabilities that could allow potentially fraudulent providers to enroll in the Medicare program.”. Case Study: S.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). Refining Definition for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare Law Today

JANUARY 11, 2023

As part of a deferred prosecution agreement, which must be approved by the court, Jet Medical admitted that it distributed misbranded devices and agreed to implement enhanced compliance measures. violated the False Claims Act by causing medical providers to submit false claims to Medicare. and Martech Medical Products Inc.,

FDA 59

FDA Governance Medicare Medicare 59

Hall Render

JANUARY 11, 2023

Federal Food, Drug, and Cosmetic (“FD&C”) Act – If an app includes a software function that meets the definition of a medical device under section 201(h) of the FD&C Act, the app may be subject to regulatory oversight by the FDA. Hall Render blog posts and articles are intended for informational purposes only.

Compliance 40

Compliance HIPAA FDA Due Diligence 40

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. Medicare covers many telebehavioral and telemental health services including audio-only services.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Healthcare Law Blog

MAY 11, 2023

THE OIG’S ANALYSIS: The OIG advised that the Arrangement would implicate the Beneficiary Inducements CMP and AKS because of the offer and transfer of remuneration to Medicare patients, potentially resulting in the purchase of laboratory services in connection with the Test. FOOTNOTES [1] 42 U.S.C. 1320a–7b(b). [2] 2] 42 U.S.C.

Medicare 52

Medicare Medicare Fraud Compliance 52

Med Com Blog

JANUARY 18, 2023

By definition, Revenue Cycle Management (RCM) is the process by which healthcare providers manage and track the revenue generated by patient care. Fraud detection: AI can be used to detect and prevent fraudulent activity in the revenue cycle, such as billing for services that were not provided or upcoding of services.

Patient Satisfaction 52

Patient Satisfaction Fraud Compliance COVID-19 52

Healthcare Compliance Blog

JUNE 9, 2022

Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare. Those claims were for presumptive and definitive Urine Drug Tests (UDTs) that were not medically reasonable or necessary and were not used to aid in the diagnosis and treatment of patients.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Overpayments 59

Health Law Advisor

APRIL 10, 2023

This interpretation provided to be difficult to apply in real world situations because while we all might think of Amazon and WalMart as big-box stores, it was not clear what other stores might also fall into this category and present a compliance risk.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

NOVEMBER 15, 2023

Billing for Advanced Practice Professionals (“APPs”) has been a challenging area for providers and practitioners because of different and changing Medicare, Medicaid and state law requirements. This standard was interpreted and applied differently by various Medicare contractors and was difficult to review/audit.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

Hall Render

JULY 12, 2023

If a deemed hospice fails to meet the Medicare requirements or shows continued condition-level noncompliance, deemed status is generally removed and oversight is placed under the SA. Selected hospices either successfully complete the SFP program or are terminated from the Medicare program. of hospice providers reported data.

Medicare 40

Medicare Medicare Nursing Homes Fraud 40

AIHC

AUGUST 8, 2023

I am a Certified Internal Healthcare Fraud Auditor (CIFHA). Both the American Society for Quality (ASQ) and Centers for Medicare and Medicaid Services (CMS) recognize this tool’s usefulness in root cause analysis (RCA). Use as many as will definitively detail the problem statement.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Health Law RX

JULY 18, 2023

Those subject to the CMP Final Rule should consider prioritizing their compliance efforts because the OIG will begin enforcing the Rule on September 1, 2023. The CMP Final Rule does not apply to healthcare providers unless they also fit the definition of Developers or HIN/HIEs.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Hall Render

SEPTEMBER 1, 2023

ALABAMA American Family Care opens new health care center in Northeast Birmingham doctors secure $13.9M Elizabeth Medical Center to receive nearly $400k in federal funds to combat substance abuse UofL lands nearly $12 million grant from National Institute of Health Winchester physician Michael Kuduk, M.D.,

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Health Law Advisor

MARCH 7, 2023

The proposed rules also clarify that a telemedicine encounter that results in a controlled substance prescription requires the health care professional treating the patient to use an interactive telecommunications system, and directly refers to the Medicare definition of that term at 42 C.F.R. Impact on Pharmacies. 4] 21 C.F.R.

Telemedicine 52

Telemedicine COVID-19 FDA Compliance 52

Hall Render

APRIL 6, 2022

The relator alleged that these programs and subsequent reporting of the retail price, and not the discounted price, violated Medicare Part D’s requirement that a pharmacy must report the usual and customary price charged for the drugs. This footnote originated as a footnote in a memorandum issued by CMS in October of 2006.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

Hall Render

NOVEMBER 28, 2023

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. Hospices need to be much more vigilant about compliance.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Healthcare Law Blog

MARCH 3, 2023

This surge was facilitated, in part, by certain flexibilities authorized by the Centers for Medicare & Medicaid Services in its response to the public health emergency (“PHE”) declared in March of 2020 and which was repeatedly renewed until now. On January 30, 2023, President Joe Biden announced that the PHE would end on May 11, 2023.

Fraud 52

Fraud Nurses Telemedicine COVID-19 52

New Jersey Healthcare Blog

JULY 22, 2022

Following a thorough review in compliance with Executive Order No. The Department denied petitioner’s request to define the term “next of kin” and add it to the definition section at N.J.A.C. The Board is also changing subsection (a) to include a definition for the term “opioid antidote.” 191 (N.J.S.A.

COVID-19 Vaccine 40

COVID-19 Vaccine Licensing COVID-19 Public Health 40

Hall Render

OCTOBER 20, 2023

Luke’s sign definitive agreement, close in on merger How Mayo Clinic Is Approaching Generative AI Risk Mitigation St. joint venture Hospitalist Companies Agree To Pay Nearly $4.4

COVID-19 Vaccine 40

COVID-19 Vaccine Nursing Homes COVID-19 Nurses 40