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

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

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

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

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

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. Additionally, the Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI), announced that it took administrative actions against 52 providers involved in similar schemes.

Fraud 59

Fraud Telemedicine Medicare Medicare 59

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

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. Accreditation.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

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.

Doctors 59

Doctors Medicare Medicare Hospitals 59

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

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. With Medicaid, the challenges are equally formidable.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Med-Net Compliance

SEPTEMBER 23, 2022

A physician pleaded guilty in federal court to falsely certifying that products and tests were medically necessary for more than 2,000 Medicare and Medicaid patients in Missouri whom he never met or examined. The orders that he signed for genetic testing for Medicaid beneficiaries caused Medicaid to be billed more than $2.5

Fraud 59

Fraud Medicaid Medicaid Telemedicine 59

American Medical Compliance

AUGUST 1, 2022

In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. This includes recommending compliance programs or trainings for staff. Get Certified.

US Department of Health and Human Services 52

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

US Department of Health and Human Services 152

US Department of Health and Human Services Fraud Medicare Medicare 152

American Medical Compliance

AUGUST 1, 2022

In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. This includes recommending compliance programs or trainings for staff. Get Certified.

US Department of Health and Human Services 52

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

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.

Fraud 40

Fraud Compliance Elder Abuse Medicaid 40

Hall Render

FEBRUARY 4, 2022

Of that, $5 billion relates to health care fraud involving drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians. That figure does not include even more funds recovered for state Medicaid programs. Health Care Fraud Actions.

Fraud 40

Fraud Governance Medicare Medicare 40

Verisys

DECEMBER 5, 2023

The Centers for Medicare & Medicaid Services (CMS) Medicare and state Medicaid lists show practitioners who have opted out of those programs. An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs.

Governance 52

Governance Licensing Malpractice Medicaid 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

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

MARCH 1, 2022

The Centers for Medicare & Medicaid Services (CMS) Medicare and state Medicaid lists show practitioners who have opted out of those programs. An Office of Inspector General (OIG) search of the List of Excluded Individuals/Entities (LEIE) indicates if the licensee is excluded from participating in government-funded programs.

Governance 52

Governance Licensing Malpractice Medicaid 52

YouCompli

APRIL 13, 2022

But tactics common in other industries might be considered illegal beneficiary inducements in healthcare, especially for beneficiaries of federal programs like Medicare or Medicaid. However, some key words and phrases should at least pique the interest of a conscientious compliance officer. “Co-pay Read more about?

Medicare 40

Medicare Medicare Governance Compliance 40

Hall Render

SEPTEMBER 1, 2023

ALABAMA American Family Care opens new health care center in Northeast Birmingham doctors secure $13.9M ALABAMA American Family Care opens new health care center in Northeast Birmingham doctors secure $13.9M Newsom announces distressed hospital loan program Kaiser Permanente frontline workers strike could begin Oct.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

MedTrainer

AUGUST 8, 2022

The Office of Inspector General for the Department of Health and Human Services is basically like the FBI of the HHS and they have a list of thousands of individuals and entities excluded from federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud.

US Department of Health and Human Services 40

US Department of Health and Human Services Medical Billing Hospitals Compliance 40

MedTrainer

FEBRUARY 13, 2022

The Office of Inspector General for the Department of Health and Human Services is basically like the FBI of the HHS and they have a list of thousands of individuals and entities excluded from federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud.

US Department of Health and Human Services 40

US Department of Health and Human Services Medical Billing Hospitals Compliance 40

Hall Render

SEPTEMBER 16, 2022

Full 4th Circuit to tackle Medicaid fraud standard under False Claims Act. Medical Impact of Roe Reversal Goes Well Beyond Abortion Clinics, Doctors Say. Massachusetts nurse pleads guilty in $100M fraud scheme. Louis County Couple Sentenced for Defrauding Medicaid. Amazon wants to add payer strategy muscle.

US Department of Health and Human Services 40

US Department of Health and Human Services COVID-19 Nurses Nursing Homes 40

CMS.gov

JUNE 20, 2018

Fraud, waste, & abuse. Over the past year, the Centers for Medicare & Medicaid Services (CMS) has engaged with the provider community in a discussion about regulatory burden issues. To achieve a truly value-based, patient-centered health care system, doctors and other providers need to work together with patients. Seema Verma.

Medicare 30

Medicare Medicare Fraud Medicaid 30

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

Hall Render

JUNE 30, 2023

after home health provider reneges on Option deal Will the doctor see you now? Here’s why. Report: Amazon Pauses 50-State Virtual Care Service Expansion UnitedHealth acquires Amedisys for $3.3B Maybe not amid the changing healthcare landscape in the US. Here’s how new laws aim to fix that.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

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. Medicaid Managed Care. What’s Needed for MCO Compliance?

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

Hall Render

MARCH 3, 2023

NATIONAL 14 rural senators push CMS to extend low-wage hospitals’ payment bump in FY2024 American Hospital Association voices support for telehealth expansion bill Behavioral health market to hit $262B by 2029 Biden administration moves to establish ‘guardrails’ for telehealth prescriptions CMS Officials Confirm End of PHE Nursing (..)

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Hall Render

MARCH 31, 2023

s Socially Determined aims to address potential gaps in Medicaid enrollment Lawsuits Mount Against DC Health Link Over Breach of Congress Members’ Data DC COVID-19 centers closing Friday Mayor Bowser Canceling $90 Million in Medical Debt for up to 90,000 DC Residents DELAWARE ChristianaCare CEO Dr.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses COVID-19 40

Hall Render

FEBRUARY 18, 2022

Only 14% of Hospitals Met Price Transparency Rule Compliance. Doctors: Pediatric COVID cases appear to be trending down. Colorado mental health professionals incensed after Medicaid forum that was intended to clear the air. Florida physician convicted of $110M fraud. Lawmakers call on Biden to end public health emergency.

COVID-19 40

COVID-19 Nursing Homes Nurses COVID-19 Vaccine 40

Hall Render

MAY 19, 2023

Supplemental Grant for Rural Health Programs UAMS to Study Affordable Care Act’s Impact on Breast Cancer Treatment Arkansas Children’s Hospital Auxiliary Donates $1.4 Supplemental Grant for Rural Health Programs UAMS to Study Affordable Care Act’s Impact on Breast Cancer Treatment Arkansas Children’s Hospital Auxiliary Donates $1.4

Nurses 40

Nurses COVID-19 Hospitals Nursing Homes 40

Healthcare IT Today

SEPTEMBER 19, 2023

Eden Avraham-Katz, VP of Legal & Compliance at 1upHealth While I appreciate the efforts to simplify the prior authorization process with FHIR APIs, the underlying issues with prior authorization are fundamentally systemic. For first responders, access to medication history is often denied altogether.

Hospitals 132

Hospitals HIPAA Nurses Governance 132

Hall Render

SEPTEMBER 23, 2022

Healthcare Compliance Will Be a Challenge in Post-PHE World. The Top Doctors Making a Difference in Delaware in 2022. A federal judge schedules a hearing on Florida’s Medicaid transgender rule. Mercer program puts primary care doctors in rural Georgia faster. million to resolve Medicare fraud claims.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40