AIHC

APRIL 10, 2024

Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.

Compliance 99

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99

American Medical Compliance

MAY 22, 2023

million to settle allegations that it paid kickbacks to healthcare providers committing fraud violations. US Efforts to Crack Down on Fraud Violations Kickbacks are illegal under the False Claims Act because they can lead to overuse or misuse of medical products, harming patients and increasing healthcare costs. Agrees to Pay $9.75

Fraud 52

Fraud Compliance Governance Doctors 52

AIHC

APRIL 10, 2024

Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 52

MedTrainer

FEBRUARY 12, 2024

Failing to report healthcare non-compliance is a lot like failing to tell your parents you got sent to the principal’s office. In this blog, we’ll outline why reporting healthcare non-compliance is non-negotiable and how software platforms make it easier to stay in compliance with the myriad regulations that govern good healthcare.

Compliance 52

Compliance Licensing Governance Fraud 52

AIHC

AUGUST 30, 2023

Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM Due to the high volume of fraud schemes involving telemarketing revealed by the Department of Justice (DOJ) over recent years, it is important that providers heed “buyer beware” when engaging with a telemarketing firm. “If If it is too good to be true it probably isn't.”

Compliance 52

Compliance Fraud Medicare Medicare 52

Healthcare Compliance Blog

JANUARY 25, 2022

A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. Discussion Points: Review your policy and procedure for preventing and reporting false claims, kickbacks, or other fraud, waste, and abuse violations.

Fraud 59

Fraud Medicaid Medicaid Medicare 59

Bill of Health

OCTOBER 30, 2023

In another legal case, a “moon” emoji was found to be possible evidence of securities fraud. A “bag of money” emoji accompanied by a “doctor” emoji is unlikely to satisfy the legal standard for disclosure. We might want to change these interactions, but we don’t have enough doctors to satisfy the demand.

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Doctors Hospitals Fraud Health Insurance 284

Verisys

APRIL 2, 2024

March 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Here is a round up of bad actors: Physician Fraud Physician pays $1.8M Million Medicare Fraud Scheme ( Full Story ) New York-Presbyterian/Brooklyn Methodist Hospital Settles Health Care Fraud Claims for $17.3

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Fraud Telemedicine Licensing Doctors 52

Verisys

MARCH 8, 2024

February 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Medicare and Medicaid Fraud Full Story Pharmacist Fraud Pharmacy Owner and Operations Manager Convicted of $2.3M Peters Physician Pleads Guilty to False Statements, Resulting in $1.4

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Med-Net Compliance

JULY 26, 2022

In connection with the enforcement action, the department seized over $8 million in cash, luxury vehicles, and other fraud proceeds. Often, these test results or durable medical equipment were not provided to the patients or were worthless to their primary care doctors.?. Billion in Healthcare Fraud appeared first on Med-Net.

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Fraud Telemedicine Medicare Medicare 59

Verisys

JANUARY 2, 2024

Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Civil Settlement with Total Access Urgent Care Over False Claims Allegations Full story Former Co-Owners of New Jersey Marketing Company Sentenced to Prison in $8.8

Fraud 52

Fraud Licensing Doctors Medicare 52

Verisys

FEBRUARY 9, 2024

January 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million Civil Judgment and Drug Treatment Center Enters Settlement to Pay $2.2

Fraud 52

Fraud Medicaid Medicaid Medicare 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. Nine Responsibilities of Healthcare Compliance Officers.

Compliance Officers 52

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

Florida Health Care Law Firm

DECEMBER 7, 2021

Telemedicine pharmacy arrangements continue to be of significant interest to fraud enforcement. The federal jury trial in the billion-dollar telehealth pharmacy fraud scheme resulted in conviction on 22 counts of mail fraud, conspiracy to commit health care fraud and introduction of misbranded drugs into interstate commerce.

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Fraud Telemedicine Governance Compliance 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

Verisys

NOVEMBER 20, 2022

Each month we will give a roundup of recent healthcare fraudsters and compliance busters. If you are looking for something to read prior to turkey or afterwards, here is a round up of bad actors: Pharma Fraud: . Pharma Fraud. Pharma Fraud . Pharma Fraud. Fraud Scheme. Fraud Scheme. Fraud Scheme .

Fraud 52

Fraud Medicaid Medicaid Nursing Homes 52

Med-Net Compliance

JULY 1, 2022

Fifteen Texas doctors have agreed to pay a total of $2,831,280 to resolve False Claims Act allegations involving illegal kickbacks in violation of the Anti-Kickback Statute and Stark Law, and to cooperate with the Department of Justice’s investigations of and litigation against other parties.

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Doctors Medicare Medicare Hospitals 59

Healthcare IT Today

MARCH 6, 2024

Clinical Decision-Making – A doctor might rely on lab results stored in the EHR to make a diagnosis. Compliance – Accurate records are required for compliance with regulations. Natural language processing (NLP) can help interpret doctor’s notes, converting them into standardized data fields.

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Doctors COVID-19 Compliance Fraud 122

YouCompli

AUGUST 29, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. As FWA continues to emerge, and poses more of a risk to organizational compliance, professionals should become familiar with some of the potential areas of noncompliance associated with telehealth.

Fraud 52

Fraud Medicare Medicare COVID-19 52

American Medical Compliance

JANUARY 9, 2024

Get Certified American Medical Compliance (AMC) is a leader in the industry for compliance, Billing, and HR solutions. To become certified, please visit us at: American Medical Compliance (AMC). This type of theft is just one example of healthcare fraud. Reach out for other courses by visiting the AMC Course Library.

Fraud 52

Fraud Medicare Medicare Compliance 52

Healthcare IT News - Telehealth

AUGUST 11, 2021

In a session at HIMSS21 on Tuesday, two HHS OIG leaders offered a look at the enforcement priorities the agency has in mind these days, and some hints about the compliance responsibilities healthcare organizations should be prioritizing in the coming months. billion, with a B, of alleged fraud. "One scheme went for $1.6

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US Department of Health and Human Services Fraud Medicare Medicare 152

YouCompli

OCTOBER 17, 2023

About two months ago, a federal jury convicted a physician on five counts of healthcare fraud for submitting over $15 million in false and fraudulent claims for patients who received COVID-19 tests at his sites. This doctor faces a maximum sentence of 50 years in federal prison – up to 10 years for each of the five counts.

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COVID-19 Compliance Fraud Doctors 52

YouCompli

JULY 26, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. As FWA in telehealth continues to emerge, and poses more of a risk to organizational compliance, professionals should become more familiar with it – and then work to curb it.

Fraud 52

Fraud Compliance Medicare Medicare 52

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.

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Compliance Officers Fraud Compliance Medicare 52

Healthcare Compliance Blog

MARCH 2, 2022

An indictment was filed on February 25, 2022, against ten persons in Florida for their alleged roles in a $67 million healthcare fraud, wire fraud kickback, and money laundering scheme. The defendants allegedly paid kickbacks and bribes to telemedicine companies in exchange for doctors’ orders for tests and durable medical equipment.

Medicare 45

Medicare Medicare Fraud Compliance 45

MedTrainer

MAY 12, 2021

The Hidden Benefits of Regulatory Compliance in Healthcare. With its maddening complexities and time- and resource-consuming demands, regulatory compliance is thought to be the plague of any thriving business. However, according to a recent Forbes Magazine article , regulatory compliance is a golden opportunity in disguise.

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Regulatory Compliance Compliance HIPAA Medical Personnel 40

YouCompli

AUGUST 22, 2023

Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs. This is a major shift in coverage patterns – and with it comes a shift in compliance scrutiny as well.

Medicare 52

Medicare Medicare US Department of Health and Human Services Compliance 52

MedTrainer

SEPTEMBER 20, 2023

Watch this one-demand webinar for insider tips straight from seasoned compliance surveyors. Examples of covered entities include health plans, clearinghouses, and certain health care providers including but not limited to: doctors, clinics, psychologists, dentists, chiropractors, nursing homes, and pharmacies.

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Medicaid Medicaid Medicare Medicare 97

Provider Trust

JANUARY 25, 2024

This report helps HHS fulfill its mission to improve the health and well-being of Americans while also providing suggestions for how healthcare organizations can stay ahead of the curve to avoid and combat fraud, waste, and abuse. Unfortunately, Medicare Advantage programs are not exempt from instances of fraud, waste, and abuse.

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Fraud Medicaid Medicaid Medicare 52

MedTrainer

AUGUST 30, 2023

Let’s explore what it means for an MCO to coordinate care for members, and the compliance implications that come with this healthcare services model. HMOs offer a comprehensive range of healthcare services through a network of doctors, hospitals, and other providers. What’s Needed for MCO Compliance? Quality of Care Standards.

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Compliance Regulatory Compliance Medicaid Medicaid 52

MedTrainer

FEBRUARY 27, 2024

And like any healthcare professional, HHAs must adhere to the compliance standards that govern quality care. It is arguably more important — and harder — to maintain a standard level of compliance when staff are working in client homes, rather than in a central facility. What is the Role of Home Health Aides?

Compliance 52

Compliance HIPAA Fraud Licensing 52

YouCompli

JANUARY 4, 2022

Unger, Chief of Medicaid Fraud Division, Office of the Massachusetts Attorney General; and Patrick Callahan, Healthcare Fraud Unit, US Attorney’s Office. Unger and Callahan addressed the Massachusetts Health and Hospital Association’s Healthcare Legal Compliance Forum in December 2021. Provider workload and compliance.

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Fraud Compliance Elder Abuse Medicaid 40

Med-Net Compliance

SEPTEMBER 23, 2022

The physician had no doctor-patient relationship with the Medicare or Medicaid beneficiaries for whom he signed orders and certified medical necessity. Discussion Points: Review policies and procedures regarding the use of telemedicine within the facility and preventing fraud, waste, and abuse.

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Fraud Medicaid Medicaid Telemedicine 59

American Medical Compliance

AUGUST 1, 2022

This includes recommending compliance programs or trainings for staff. By analyzing fraud, waste, and abuse occurring in the medical system, the HHS is able to put regulations in place to minimize risks for patients and providers. American Medical Compliance (AMC) is a leader in the industry for compliance, Billing, and HR solutions.

US Department of Health and Human Services 52

US Department of Health and Human Services Nursing Homes COVID-19 Medicare 52

American Medical Compliance

AUGUST 1, 2022

This includes recommending compliance programs or trainings for staff. By analyzing fraud, waste, and abuse occurring in the medical system, the HHS is able to put regulations in place to minimize risks for patients and providers. American Medical Compliance (AMC) is a leader in the industry for compliance, Billing, and HR solutions.

US Department of Health and Human Services 52

US Department of Health and Human Services COVID-19 Nursing Homes Medicare 52

Provider Trust

JULY 26, 2022

On June 7, 2022, Theresa Pickering of Norcross, Georgia was indicted by a federal grand jury on federal charges of health care fraud, aggravated identity theft, and distribution of controlled substances. In addition to these allegations of fraud, waste, and abuse, Pickering had a history of fraud. Further, Ms.

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Licensing Fraud Compliance Nurses 52