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. For healthcare organizations, understanding UPIC audits and preparing for them is essential to compliance. What is the Purpose of UPIC Audits?

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MedTrainer

OCTOBER 4, 2023

To ensure organizations meet these standards, federal healthcare compliance requirements have been put in place. These regulations and laws help maintain patient confidentiality, ensure quality care, and prevent fraud and abuse within the healthcare industry. What Are Federal Healthcare Compliance Requirements?

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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.”

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Medisys Compliance

NOVEMBER 6, 2023

Introduction Orthopedic billing compliance is essential for healthcare providers to avoid costly audits and penalties. By following a comprehensive orthopedic billing compliance checklist, providers can ensure that their claims are accurate, complete, and supported by proper documentation.

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Compliance Medical Billing Outsourcing Medical Billing ACA 59

Verisys

MAY 3, 2023

7 Core Elements of Healthcare Compliance Plan and How to Measure Them Healthcare compliance regulations are complex and ever-changing, but are an essential part of any healthcare organization’s effort to provide safe, high-quality care for patients. What is an effective healthcare compliance program?

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Innovaare Compliance

MAY 26, 2022

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The post CMS Reminder of Medicare Fraud, Waste and Abuse Vigilance appeared first on Inovaare.

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C&M Health Law

JANUARY 25, 2023

hospitalizations and emergency department visits) and to audit Medicare claims to assess potential fraud. In November 2020, the Centers for Medicare & Medicaid Services (CMS) announced the Acute Hospital Care At Home program to provide hospitals expanded regulatory flexibility and allow them to care for eligible patients in their homes.

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HIPAA Journal

JANUARY 30, 2023

The National HIPAA Summit is the leading forum on healthcare EDI, privacy, breach notification, confidentiality, data security, and HIPAA compliance, and the deadline for registration for the Virtual 40th National HIPAA Summit is fast approaching.

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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). This type of theft is just one example of healthcare fraud. Reach out for other courses by visiting the AMC Course Library.

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Healthcare Compliance Blog

APRIL 26, 2022

The compliance documents include special fraud alerts, advisory bulletins, podcasts, videos, brochures, and papers providing guidance on compliance with federal healthcare program standards. Toolkits: The OIG has created several toolkits to help providers ensure they are in compliance with healthcare laws.

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US Department of Health and Human Services Fraud Compliance Medicaid 59

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.

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Compliancy Group

FEBRUARY 29, 2024

By examining the purpose and regulatory mechanisms of these agreements, we can understand their role in ensuring compliance, promoting ethical conduct, and ensuring patient and employee safety. When a hospital, doctor’s office, or other healthcare organization is guilty of a regulatory or compliance violation , the U.S.

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Compliance Compliance Officers Overpayments Overpayment 52

YouCompli

JANUARY 18, 2023

Featured speakers : Eric Gold , Chief, Massachusetts Attorney General’s Office Healthcare Division; Jennifer Goldstein , Managing Attorney, Medicaid Fraud Division, Massachusetts Attorney General’s Office; and Steven Sharobem , Assistant US Attorney, District of Massachusetts. Moderated by David S.

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Fraud COVID-19 Compliance Medicaid 52

HIPAA Journal

JULY 24, 2023

Healthcare providers participating in federal healthcare programs are advised to regularly check the HHS OIG Exclusions List to avoid penalties for non-compliance with §1128 of the Social Security Act. This article answers the following: What is the HHS Office of Inspector General? What is the HHS OIG Exclusions List?

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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 154

Med-Net Compliance

OCTOBER 13, 2022

The case was investigated and prosecuted by the Medicaid Fraud Control Unit, a division of the North Dakota Attorney General’s Office, with assistance from the local police department. I want to thank the Medicaid Fraud Control Unit for thoroughly investigating this crime and successfully pursuing justice.

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Nursing Homes Nurses Fraud Medicaid 59

Health Law RX

JUNE 2, 2023

The Prior SafeCo Standard Until yesterday, defendants could seek dismissal of fraud claims based on the absence of scienter by relying on the two-part test codified by the Court in SafeCo Ins. A mistake is still a mistake, not fraud. of America v. 3] That test posed two questions. per 30-day supply). [9] per 30-day supply). [10]

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Fraud Governance Medicaid Medicaid 52

Verisys

JANUARY 25, 2023

In short, an entity will lose the ability to service patients or members with Medicare or Medicaid insurance. While sanctions lists are constantly evolving and expanding, compliance with Health and Human Services (HHS) Office of Inspector General (OIG) standards are becoming more stringent. Death, but identifying a sanction is common.

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Compliance Fraud Telemedicine Licensing 52

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.

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Fraud Governance Medicare Medicare 40

Compliancy Group

MAY 27, 2022

Let’s Simplify Compliance HIPAA and cybersecurity go hand-in-hand. × HIPAA Compliance Simplified. The complaint further alleges that the affected patients have suffered anxiety and loss of time and now face a substantial risk of fraud and identity theft due to this data breach. Learn More! × Find Out More! . *We

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HIPAA Ransomware Compliance Hospitals 98

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. This critical information can help identify or avoid serious adverse events, including hospital readmissions.

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Hall Render

MARCH 8, 2024

DC Health moves to Anacostia with high hopes for community impact VIP health system for top US officials risked jeopardizing care for rank-and-file soldiers Health workers partner with churches to target kidney disease among DC’s Black residents DELAWARE ChristianaCare taps population health exec from Virtua ChristianaCare’s medical director takes (..)

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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.

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

Hall Render

MAY 5, 2023

healthy village’ George Washington University medical residents vote overwhelmingly to form a union Kaiser Permanente’s Mid-Atlantic president, Ruth Williams-Brinkley, to retire Kaiser Permanente to spend billions on new value-based care nonprofit based in the D.C. of Iowa Health Care denies sharing patient data with Facebook, but are they right?

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

Hall Render

AUGUST 11, 2023

News & World Report recognizes five Northern Light Eastern Maine Medical Center services as ‘high performing’ Deer Isle nursing home offers naming opportunities to meet $1.5M million to combat lack of health care providers in rural communities ‘Conscience’ bills let medical providers opt out of providing a wide range of care St.

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

Hall Render

MAY 19, 2023

Chicago system names COO CommonSpirit’s operating losses swell, sparking job cuts Illinois hospital agrees to pay $12.5 operating loss in Q2 As RI legislators near session’s end, compromise on expensive proposals looks inevitable ‘It is wrong’: Charlesgate workers ask state to keep nursing home open.

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New Jersey Healthcare Blog

JULY 22, 2022

Following a thorough review in compliance with Executive Order No. The chapter describes the policies and procedures of the New Jersey Medicaid/NJ FamilyCare program regarding transportation services. On April 4, 2022, at 54 N.J.R. 13:44F with amendments. On April 4, 2022, at 54 N.J.R. See N.J.A.C. On April 4, 2022, at 54 N.J.R.

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