MedTrainer

DECEMBER 4, 2023

Healthcare compliance in North Dakota differs in several ways from other states, primarily influenced by the state’s rural character and unique healthcare priorities. Additionally, the state’s approach to Medicaid expansion involves unique waivers, impacting eligibility criteria and cost-sharing provisions.

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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.

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

MedTrainer

NOVEMBER 20, 2023

Similar to other states, maintaining healthcare compliance in Florida State involves meeting state-specific regulations and requirements. This post offers an overview of must-know compliance requirements for Florida. While many states have rules that prohibit the storage of Medicaid data outside the U.S.,

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MedTrainer

NOVEMBER 5, 2023

Colorado, like other states in the United States, has its own set of regulations and requirements that make managing healthcare compliance in Colorado tricky. To effectively manage compliance, healthcare organizations must establish a robust system for monitoring and interpreting these changes and swiftly implement necessary adjustments.

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Medisys Compliance

MARCH 21, 2023

What is Credentialing Doctors? Credentialing of doctors is a process that involves the evaluation of a doctor’s qualifications, education, training, licensure, and experience to determine if they meet the requirements set by the insurance company.

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MedTrainer

NOVEMBER 30, 2023

Minnesota, distinct from other states, carries a unique landscape of regulations and standards that govern its healthcare compliance. Navigating and managing compliance in Minnesota can certainly be a challenge for providers and facilities. Juggling top-notch patient services and the state’s compliance requirements is no easy task.

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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. The DME companies would then submit the reimbursement claims to Medicare and Medicaid. General Legal Duties and Antitrust Laws.

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Med-Net Compliance

JUNE 15, 2022

California Attorney General Rob Bonta announced a settlement against a Southern California doctor for submitting false claims to Medicare and Medi-Cal between the years of 2011 and 2018 for drugs, procedures, services, and tests that were never administered to patients. As part of the settlement, the doctor will pay a total of more than $9.48

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AIHC

AUGUST 30, 2023

What compliance issues need to be considered when drafting a marketing strategy? Let’s take a closer look at potential compliance risks. As with all marketing strategies, remember Compliance, Compliance, Compliance! So, what is telemarketing in healthcare ? Great idea, right? I can’t say it enough.

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Bill of Health

SEPTEMBER 9, 2022

And we know that our prisons, jails, and detention centers employ doctors with suspended and limited licenses as the exclusive source for health care for incarcerated people. health law and policy is the exclusion of people in custody in prisons, jails, and detention centers from Medicaid. These voluntary standards, within the U.S.

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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.”

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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.”

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

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

Compliancy Group

FEBRUARY 16, 2024

We also covered two Medicaid fraud schemes , one resulting in billions of dollars in billing for medical supplies that were never received. for Medicaid Fraud In March 2014, the Maryland Board of Dental Examiners received complaints against Seyed Hamid Tofigh, DDS, claiming the dentist posed a risk of harm, and suspended his license.

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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.

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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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Compliancy Group

FEBRUARY 12, 2024

In one incident, a New Jersey pharmacy admitted to conspiracies to defraud benefits providers, including Medicare and Medicaid, of $65 million for medications never provided to patients. They paid bribes, kickbacks, set up phony jobs in doctors’ offices. Bribes included payment by check, wire transfer, cash, and expensive meals.

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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

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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

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HIT Consultant

MAY 14, 2024

Building on a Strong Legacy Todd’s impressive career boasts senior regulatory attorney roles, with a deep understanding of compliance, commercial contracting, and regulatory law. Before joining Kalderos, he served as Assistant General Counsel at Johnson & Johnson, focusing on legal, compliance, and consumer cost issues.

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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?

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Verisys

NOVEMBER 20, 2022

Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Pain management doctor gave patients steroid injections even after patients complained of negative side effects. The group steered members to bill Medicaid rather than going through the NICA. Pharma Fraud. Pharma Fraud . Pharma Fraud.

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Healthcare IT Today

DECEMBER 12, 2023

The latest policy update from The Centers for Medicare and Medicaid Services (CMS) adds key provisions to the December 2022 proposed rule requiring adoption of a new NCPDP SCRIPT standard version. NCPDP SCRIPT Standard Version 2023011 : Creates a novel medication management framework to promote innovation between doctors and pharmacists.

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Florida Health Care Law Firm

APRIL 20, 2022

When a patient feels their doctor has violated their code of ethics or responsibility, they are encouraged to file a complaint with the state. How to File a Complaint Against a Doctor in Florida. The post How to File a Complaint Against a Doctor in Florida first appeared on Florida Healthcare Law Firm.

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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). Buy Course Today The post Safeguarding Against Medical Identity Theft Training appeared first on American Medical Compliance.

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Health Care Law Brief

FEBRUARY 2, 2023

However, with less than four months until that date, providers must quickly review their operations and ensure their continued compliance with billing requirement changes that will result from the PHE’s expiration.

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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.

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Medisys Compliance

APRIL 1, 2024

Patients can now access convenient and timely consultations with their doctors remotely, improving access to care and reducing healthcare disparities. Maximizing Reimbursement for Telehealth Services Stay Informed: Keep yourself updated on the latest telehealth billing regulations from Medicare, Medicaid, and private insurers.

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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.

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

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Provider Trust

JANUARY 25, 2024

Ensuring the Financial Integrity of HHS Programs In fiscal year (FY) 2022, improper payments within healthcare programs like Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) were estimated at a staggering $131.6 With Medicaid, the challenges are equally formidable.

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MedTrainer

JUNE 29, 2023

By setting restrictions on how physicians refer designated health services, Stark Law makes it impossible for your doctor to act outside of your best interests. Individuals or entities found in violation of Stark Law may face exclusion from participation in federal healthcare programs such as Medicare and Medicaid.

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Medisys Compliance

JULY 10, 2023

HP Modifier – Psychologist or Doctorate Level (PsyD or Ph.D.) The HP modifier is used to identify mental health services provided by psychologists or professionals with a doctorate-level degree (PsyD or Ph.D.). AH Modifier – Doctorate Level or Clinical Psychologist (Ph.D. or PsyD) in clinical psychology.

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MedTrainer

MARCH 8, 2024

These financial incentives are from agencies such as the Centers for Medicare and Medicaid Services (CMS) and the Health Resource & Services Administration (HRSA) , who are working to achieve health equity and improve public health. FQHCs can participate in APMs through Medicare and Medicaid Managed Care Organizations (MCOs).

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Kaiser Health News

MAY 21, 2024

“We want the Centers for Medicare & Medicaid Services to hold these brokers criminally responsible for ripping people off this way,” he told KFF Health News. Stronger actions are needed immediately to thwart insurance brokers who fraudulently enroll or switch people in Affordable Care Act coverage, Sen.

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Healthcare IT Today

FEBRUARY 7, 2024

Traditionally, the doctor has given a paper prescription to the patient, who delivers it to the pharmacy. Various analytics can also be performed during and afterward to see which doctors are doing a suspicious amount of prescribing. Hence the multitude of federal and state oversight mechanisms to prevent abuse.

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Healthcare IT Today

JANUARY 23, 2024

All these digital health companies bring in expert doctors, nurses, or other clinical staff to help them design products and interact with potential customers. Digital vendors want doctors to be willing to move faster and iterate over evolving solutions in digital technology.

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